LEY 39 LIBRARY Borough of Lepton. HEALTH REPORT FOR THE YEAR I945. 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. Mayor, Ladies and Gentlemen, I have the honour to present herewith my Annual Report on the health, sanitary circumstances and vital statistics of the Borough of Leyton during the year 1945, together with my Annual Report to the Education Authority on the work of the school medical service during the year. These reports are drawn up on the lines required by the Ministry of Health and the Board of Education. During each year since the outbreak of war the Central Government Departments controlling health and education have issued instructions that the Annual Reports of Medical Officers of Health and School Medical Officers should be abbreviated as far as possible, and similar instructions have been issued in respect of Annual Reports for 1945. Under the circumstances the report which follows will be found to consist almost entirely of the dry bones of public health activity—facts and figures in the form of statistical tables required by the Ministries of Health and Education. Although such information makes dull reading, it is necessary to find out and record the facts in order that we may be in a position to lay a sure foundation in the measures to be adopted for advancement of the public health. Vital Statistics. The last official census return—that for the year 1931— showed the population of Leyton to be 128,313 persons. By the last pre-war year (1938) the Registrar General's estimate of the population was 117,200; and his estimated figure—the figure from which all vital statistics are calculated—for the year 1945 is 87,330. The number of births registered in the Borough during 1945 was 1,474, giving a birth rate of 16.87 per thousand of the population. Deaths of Leyton residents certified during the year numbered 1,147, giving a general death rate of 13.13 per thousand. Three women died from diseases and accidents of pregnancy and childbirth—maternal mortality rate 1.99 per thousand total (live and still) births. The number of deaths of infants under one year of age was 52—infantile mortality rate 35.27 per thousand live births. 2 An analysis of the vital statistics, along with a table showing the comparative annual figures since 1892, are to be found in the body of the report. (Page 16.) The vital statistical figures contained in this report relate only to illnesses which are notifiable, or those which have caused death. The great mass of minor ailments, which cause so much invalidity in the community, are not recorded; and a recent war-time social survey undertaken by the Ministry of Health gives no grounds for complacency. It is possible that reaction after prolonged war strain may be formidable, and that the improvement in vital statistics may not be maintained. The Public Health. It had been expected that the horrors and physical hardships of intensive warfare would have a catastrophic effect on the physical and mental health of the civil population; but there is no evidence, at least from vital statistics, of any deterioration. In spite of the many adverse influences endured—intensive bombing, curtailment of essential services, disruption of family life, large scale evacuation of the population, overcrowding, the depressing effect of the black-out, etc.—the general health of the community throughout the war years remained at a surprisingly high level. With regard to nutrition it may be said that—in consequence of the more even distribution of food, sufficient in quantity and quality to meet physical requirements—the general mass of the population has never been better fed. Although few may have had optimum feeding, no one had much short of it. Six years is a long time for war-time food rationing, and if our rations had been insufficient in food value we should by now be having a great increase in deficiency diseases, but there is no evidence of this. Since the end of hostilities there has been an increase in illnesses, but they appear to be of mental rather than physical origin. During the war years we have been shattered mentally and morally, and only time will tell how much that mental strain will give rise to increase in psychosomatic diseases which do not respond well to treatment. Infectious Diseases. The general level of incidence of the commoner notifiable infectious diseases still remains low, as it has done during the war years. During the year under review measles was epidemic; 3 797 cases were notified, of whom one died. In spite of plans and preparations to meet a possible epidemic of influenza during the autumn and winter months, the incidence remained low. No new form of infectious disease has appeared; and there is some evidence of a diminution in the increased incidence of tuberculosis and venereal disease which occurred during the war years. In consequence of the overcrowding in shelters and in homes, the interference with water supplies and other amenities, etc., there occurred during 1940 a very marked increase in verminous conditions and scabies, necessitating the establishment of a special cleansing and treatment centre. It will be seen from the figures contained in the body of this report that the number of such cases has been declining progressively since 1942. Sanitary Circumstances. During the war years, as the result of enemy action, 1757 dwelling houses in the Borough were totally demolished; 3,178 were damaged so severely that they were unfit for occupation; 3,172 received damage to such an extent that extensive repairs were necessary; and 19,831 received minor damage. In consequence of such widespread havoc it will be appreciated that a large percentage of the population has had to endure great overcrowding and lack of hygienic amenities. It is unfortunate that, at a time when their services were so much in demand, the Council's staff of sanitary inspectors has been so much depleted. The staff of sanitary inspectors during 1945 was 6, compared with 10 before the war. All matters connected with rehousing and the allocation of Council houses are now dealt with by a special Rehousing Department under the control of the Borough Treasurer. Health Service Premises—War Damage. During the year the Council's two Health Centres and two Day Nurseries sustained further substantial damage due to enemy action. Whereas it was possible to resume work—although under somewhat difficult conditions—at three of these premises within a few days after the incidents, in the case of Ellingham Road Nursery the damage was so severe that the nursery had to be closed from 17th February until 11th June. 4 As the result of enemy action during the winter of 1940-41 Park House Health Centre sustained very severe damage, involving the total demolition of the waiting hall, dispensary, kitchen and store. Since that time it has been damaged on more than one occasion; but the lack of the premises totally destroyed in the original London 'blitz' interferes seriously with the normal activity of the Centre. As the attendances at the Centre are now greater than before the war, mothers and children are subjected to considerable discomfort and congestion due to having to wait in overcrowded passages not intended for the purpose. Maternity and Child Welfare. The Council's medical and nursing services have been carried on all through the war years, and the figures shown in the appropriate section of the report give some indication of the extent to which they are taken advantage of by women and children in the Borough. Towards the end of the year under review, owing to a sharp rise in the birth rate, it became evident that maternity bed accommodation throughout the country was not available for all women who desired to have their confinements in institutions; and, in accordance with the suggestion of the Ministry of Health, it has been necessary to apply a somewhat rigid selection of cases for admission to hospital. The war has given rise to many new problems affecting the daily life and health of the expectant and nursing mother— shortage of housing accommodation for young married couples, lack of domestic help, shortage of maternity beds, etc.; and much of the time of health visitors and midwives is now devoted to dealing with anxious enquiries to which—in so many cases—no satisfactory answer can be given, and in trying to solve problems which are well-nigh insoluble. No addition had been made to the Council's staff of health visitors since August, 1930; and, as it was becoming increasingly difficult to carry out the necessary home visiting of infants and young children, an additional health visitor was appointed in August, 1945. One of the municipal midwives was unable to practise for eight months due to the existence of a persistent throat infection. 5 Daring the war years the Council has continued its arrangement with the Essex County Nursing Association for domiciliary midwifery in the eastern part of the Borough; and it is gratifying to record the satisfactory and cordial spirit of co-operation which exists between the Council and the Matron and midwifery staff of the Association. The two War-time Day Nurseries have been maintained during the year. Acting on suggestions contained in Ministry of Health Circular S.R.O. No. 123, it was no longer considered necessary to keep the nurseries open so long as during the war period; and since October, 1945, the hours have been 8 a.m. to 5.30 p.m. on weekdays, and 8 a.m. to 1 p.m. on Saturdays. School Medical Service. In my previous Annual Report I pointed out that some 3,416 Leyton schoolchildren were in reception areas. By July, 1945 those schoolchildren who had been evacuated to reception areas under the Government Evacuation Scheme had returned to Leyton. After the initial wholesale evacuation of school children at the outbreak of war, normal full-time schooling was resumed in July, 1940. For the whole of the war period, in spite of shortage of staff and other difficulties, the school medical service has been maintained, and nutritional surveys have disclosed no appreciable deterioration in general nutrition when compared with the prewar years. As the result of intensive bombing, destruction of dwellings, overcrowding at home and in public shelters etc., it is no matter for surprise that there has been a fall in standards of cleanliness and an increase in skin infections. In other respects the school child appears to have lost none of the physical gains acquired during pre-war years. There can be no doubt that the provision of school meals and milk has had a most salutary effect in preserving the health and nutrition of school children during the war years. In accordance with the provisions of the Education Act, 1944, the County Council became the Local Education Authority on 1st April, 1945; and has delegated the actual school medical service arrangements to the medical, dental, nursing and specialist staff of the former Leyton Education Authority. By so doing it has been possible to preserve that continuity of medical supervision which is so desirable. 6 Civil Defence Casualty Service. In spite of the great amount of time and energy devoted to the organisation, staffing, equipment and operation of the Council's Civil Defence Casualty Services during the war years, at the request of the Government Departments concerned and in the interests of national security no reference to these activities has been made in any of my annual reports. I should like to take this opportunity of conveying to all members of the Council's Civil Defence Casualty Services, both full-time and part-time, my sincere appreciation of their loyal and devoted service. General. Ever since 1935 the Committees and staff responsible for the work of the Health Department have been engaged in organising and operating formidable services designed to preserve the health and sanitary environment of those who were fortunate enough to escape personal injury from enemy action, and to minister to the suffering of those not so fortunate. It would be impossible in a report such as this to describe in detail the manifold special wartime services for which the Department was responsible, or to give any adequate idea of the indomitable spirit which was shown in the shouldering of responsibilities foreign to the work of a Health Department in time of peace. These extra war-time services could not have been operated without the loyal devotion to duty and whole-hearted co-operation of the members of the permanent staff of the Department, to whom I accord my sincere appreciation and thanks. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, 8 Extract from Vital Statistics for the year 1945. Live Births:— Legitimate Males 725 Females 654 Illegitimate Males 42 Females 53 Totals 1,474 Birth Rate per 1,000 of population 16.87 Stillbirths:— Males 15 Females 19 Rate per 1,000 total (live and still) births 22.54 Deaths:— Males 606 Females 541 Totals 1,147 Death Rate per 1,000 13.13 Number of women dying from diseases and accidents of pregnancy and childbirth:— From Sepsis 0 From other causes 3 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 35.27 Legitimate infants per 1,000 legitimate live births 33.35 Illegitimate infants per 1,000 illegitimate live births 63.15 Deaths from Cancer (all ages) 189 ,, ,, Measles (all ages) 1 „ „ Whooping Cough (all ages) 2 ,, ,, Diarrhoea (under 2 years of age) 2 TABLE 1. Registered Births, 1945. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 1 7 4 8 4 7 7 3 3 3 47 February 3 6 2 5 5 8 4 4 6 2 45 March 3 6 4 8 2 4 3 2 7 3 42 April 2 8 3 1 5 2 7 4 2 — 34 May 3 2 2 3 8 5 6 3 7 1 40 June 2 4 3 4 8 5 5 3 2 2 38 July 2 5 1 6 6 4 5 4 2 3 38 August 3 9 5 4 9 1 7 6 4 3 51 September 4 3 4 2 7 4 6 3 3 3 39 October 4 7 2 2 4 6 12 2 1 1 41 November 3 8 3 2 9 6 4 10 2 1 48 December 1 7 6 4 4 2 6 6 2 2 40 Transferables 71 177 63 80 173 144 66 74 79 44 971 Totals 102 249 102 129 244 198 138 124 120 68 1,474 6 TABLE 2. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1945. Sex. All Ages. Ages at Death in Years. In Public Institutions in the District 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 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 2 1 ... ... 1 ... ... ... ... ... ... ... ... ... 5. Diphtheria M 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system M 20 1 ... ... ... 4 3 3 4 3 2 ... ... ... F 15 ... ... ... ... 3 4 3 2 1 2 ... ... ... 7. Other forms of tuberculosis M 3 ... ... ... ... 1 ... 1 ... ... 1 ... ... ... F 3 ... ... 1 ... 1 1 ... ... ... ... ... ... ... 8. Syphilitic disease M 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... F 3 ... ... ... ... ... ... 2 ... 1 ... ... ... ... 9. Influenza M 2 1 ... ... ... ... ... ... ... ... ... 1 ... ... F 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... 10. Measles M 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) M 8 ... ... ... ... ... ... ... 1 1 3 3 ... ... 13. Cancer of uterus F 7 ... ... ... ... ... ... ... l 3 2 1 ... ... 14. Cancer of stomach and duodenum M 18 ... ... ... ... ... ... ... 2 4 8 4 ... ... F 24 ... ... ... ... ... ... ... ... 8 7 9 ... ... 10 15. Cancer of breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 13 ... ... ... ... ... ... 2 1 1 6 3 ... ... 16. Cancer of all other sites M 83 ... ... ... ... ... 4 4 13 21 20 21 ... ... F 36 ... ... ... ... ... 2 4 3 10 7 10 ... ... 17. Diabetes M 2 ... ... ... ... ... 1 ... ... 1 ... ... ... ... F 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... 18. Intra-cranial vascular lesions M 52 ... ... ... ... ... 1 1 2 16 16 15 ... ... F 55 ... ... ... ... ... ... 1 2 14 19 19 ... ... 19. Heart disease M 152 ... ... ... ... ... 1 3 10 35 55 48 ... ... F 141 ... ... ... 2 1 6 3 6 17 48 58 ... ... 20. Other diseases of circulatory system M 15 ... ... ... ... ... ... ... ... 5 4 6 ... ... F 18 ... ... ... ... ... ... 1 1 2 6 8 ... ... 21. Bronchitis M 76 ... ... 1 ... ... ... 2 2 24 26 21 ... ... F 36 4 ... ... ... ... ... ... ... 4 12 15 ... ... 22. Pneumonia M 18 5 ... ... ... ... ... ... 2 7 3 1 ... ... F 19 5 ... 1 1 ... ... 2 2 1 1 6 ... ... 23. Other respiratory diseases M 4 ... ... ... ... ... ... ... ... 1 1 2 ... ... F 7 ... ... ... ... ... ... ... 3 1 2 1 ... ... 24. Ulceration of the stomach or duodenum M 6 1 ... ... ... ... ... ... 2 2 ... 1 ... ... F 2 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 25. Diarrhoea (under 2 years of age) M 2 2 ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26. Appendicitis M 4 ... ... ... ... ... ... 1 ... ... 1 1 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27. Other digestive diseases M 10 ... ... ... ... ... ... ... 1 1 6 2 ... ... F 11 ... ... ... ... ... ... 1 1 2 4 3 ... ... 28. Nephritis M 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... F 4 ... ... ... ... 1 1 ... ... ... ... 2 ... ... 29. Puerperal and post-abortive sepsis. F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other maternal causes F 3 ... ... ... ... 1 2 ... ... ... ... ... ... ... 31. Premature birth M 3 3 ... ... ... ... ... ... ... ... ... ... ... ... F 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 32. Congenital malformations M 16 14 2 ... 1 ... ... ... ... ... ... ... ... ... F 8 6 1 ... 1 ... ... ... ... ... ... ... ... ... 33. Suicide M 3 ... ... ... ... ... ... 1 ... 1 1 ... ... ... F 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... 34. Road traffic accidents M 5 ... ... ... 1 ... ... ... 1 1 1 1 ... ... F 2 ... ... ... ... ... ... ... 1 ... ... 1 ... ... 35. Other violent causes M 32 3 1 1 5 ... 5 5 5 2 3 2 ... ... F 44 4 ... 2 1 8 6 3 6 6 3 5 ... ... 36. All other causes M 65 ... 1 ... 2 ... ... 3 3 5 11 40 ... ... F 78 ... ... ... ... 3 2 ... 2 2 8 61 ... ... Totals M 606 52 5 6 19 25 40 46 80 207 294 373 1,676 472 F 541 11 TABLE 3. DEATHS IN WARDS, 1945. 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 ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal fever ... 1 ... ... ... ... ... ... ... ... ... 3. Scarlet fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough ... ... ... 1 ... ... ... ... 1 ... ... 5. Diphtheria ... ... ... ... ... 1 ... 1 ... ... ... 6. Tuberculosis of respiratory system 3 5 2 2 4 6 5 2 3 3 ... 7. Other forms of tuberculosis ... 3 1 1 ... 1 ... ... ... ... ... 8. Syphilitic diseases ... 1 1 2 ... ... 1 ... ... ... ... 9. Influenza ... ... ... ... 1 ... ... 1 1 ... ... 10. Measles ... ... ... ... ... ... ... 1 ... ... ... 11. Acute poliomyelitis and polioencephalitis ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis ... ... ... ... ... 1 ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) ... ... ... 2 3 1 2 ... ... ... ... 13. Cancer of uterus ... 2 ... ... 1 2 1 ... ... l ... 14. Cancer of stomach and duodenum 4 9 ... 7 7 3 5 ... 1 3 ... 15. Cancer of breast 3 1 ... ... 2 4 ... 2 ... 1 ... 16. Cancer of all other sites 12 19 ... 12 21 13 8 10 11 4 ... 17. Diabetes ... 1 ... 1 1 ... ... 1 ... ... ... 18. Intra-cranial vascular lesions 3 14 4 14 16 12 9 15 16 5 ... 19. Heart disease 31 44 16 27 43 44 13 31 27 16 1 20. Other diseases of circulatory system 4 2 ... 2 10 6 1 4 3 1 ... 21. Bronchitis 4 19 7 15 19 13 4 15 7 9 ... 22. Pneumonia 4 8 3 2 4 4 3 4 3 2 ... 23. Other respiratory diseases ... 2 ... 2 2 1 1 2 1 ... ... 24. Ulcer of stomach or duodenum 2 ... 1 3 ... 2 ... ... ... ... ... 12 25. Diarrhoea (under 2 years) 1 ... 1 ... ... ... ... ... ... ... ... 26. Appendicitis ... ... ... ... ... 1 ... 1 1 1 ... 27. Other digestive diseases 2 4 2 3 3 3 2 ... 2 ... ... 28. Nephritis ... 1 1 ... 1 1 1 ... 1 ... ... 29. Puerperal and post-abortive sepsis ... ... ... ... ... ... ... ... ... ... ... 30. Other maternal causes ... ... 1 ... 2 ... ... ... ... ... ... 31. Premature birth ... ... ... ... 1 2 1 ... 1 ... ... 32. Congenital malformations 3 5 1 ... 3 2 2 2 3 2 ... 33. Suicide 2 ... 2 1 ... ... ... ... ... ... ... 34. Road Traffic accidents ... ... ... ... 3 1 2 ... 1 ... ... 35. Other violent causes ... 4 24 3 7 12 3 ... 3 20 ... 36. All other causes 10 27 7 18 14 18 9 16 14 10 ... Totals 89 172 86 118 168 154 73 108 100 78 1 13 TABLE 4. Vital Statistics of Whole District during 1945 and Previous Years. Births. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Year. Inward Transferable Nett. Number. Rate. 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. 1 3 4 5 6 7 8 9 10 11 12 13 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 1505 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 286 73 50.27 1123 12.91 1943 871 1595 18.14 2769 31.5 1810 289 57 35.73 1248 14.20 1944 1003 1613 18.87 2779 32.5 1778 284 68 42.15 1285 15.04 1945 971 1474 16.87 2644 30.3 1698 201 52 35.27 1147 13.13 14 TABLE 5. Birth-rate, Death-rate and Analysis of Mortality During the Year 1945. 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 16.1 0.46 11.4 0.00 ... 0.02 0.00 0.02 0.02 0.08 5.6 46 ... ... ... ... 126 County Boroughs and Great Towns, including London 19.1 0.58 13.5 0.00 ... 0.02 0.00 0.02 0.02 0.07 7.8 54 ... ... ... ... 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 19.2 0.53 12.3 0.00 ... 0.02 0.00 0.01 0.02 0.07 4.5 43 ... ... ... ... London 15.7 0.40 13.8 0.00 ... 0.01 0.00 0.02 0.01 0.07 7.6 53 ... ... ... ... LEYTON 16.8 0.38 13.13 0.00 ... 0.01 0.00 0.02 0.02 0.04 1.4 35 84.8 2.7 12.5 ... 15 16 TABLE 6. Comparative Statistics of Births, Mortality, Etc. LEYTON, 1892-1945. Year. Population. Births. Birth Rate. Deaths. Death Rate. Deaths under 1 year. Infantile Death Rate. 1892 63000 2210 35.08 972 15.4 313 141 1893 64000 2316 36.18 1019 15.7 306 130 1894 70000 2224 31.7 825 11.6 258 116 1895 75000 2292 30.05 1080 14.4 346 150 1896 77000 2372 30.08 926 11.8 326 137 1897 85000 2501 29.3 1011 11.9 356 142 1898 90000 2560 28.4 1125 12.5 374 146 1899 93000 2698 29.0 1262 13.5 420 155 1900 100000 2932 29.32 1179 11.8 410 140 1901 100000 2963 29.63 1243 12.4 404 136 1902 100000 3152 31.52 1183 11.8 336 106 1903 102000 3273 32.08 1112 10.9 322 99 1904 104000 3198 30.07 1370 13.1 444 138 1905 105000 3209 30.05 1177 11.2 303 94 1906 108000 3344 30.9 1327 12.2 382 114.5 1907 120000 3190 26.6 1269 10.6 182 86.6 1908 121200 3071 25.3 1185 9.8 242 78.8 1909 121200 2979 24.6 1208 9.9 244 81.9 1910 123300 3011 24.4 1112 9.0 191 63.4 1911 124736 2931 23.5 1473 11.8 327 116.6 1912 126700 2797 22.1 1343 10.6 223 79.7 1913 129366 2904 22.4 1336 10.3 242 83.3 1914 130847 2800 21.4 1363 10.4 219 78.2 1915 124497 2655 21.3 1510 12.1 225 84.7 1916 B132107* 2560 19.4 1471 12.1 197 76.9 D121420* 1917 B125352* 2005 16.0 1414 12.6 172 85.8 Dl12452* 1918 B125352* 1791 14.3 1723 15.3 161 89.9 Dl12452* 1919 B129062* 2195 17.0 1397 11.3 154 70.16 D123896 1920 128832* 3168 24.6 1330 10.3 207 65.34 1921 128432 2679 20.86 1290 10.04 182 67.94 1922 131600 2416 18.36 1420 10.79 155 64.16 1923 132800 2328 17.53 1228 9.25 106 45.53 1924 133500 2101 15.74 1325 9.92 ' 110 52.36 1925 132700 2091 15.76 1349 10.16 114 54.51 1926 130000 2022 15.55 1261 9.7 131 64.79 1927 128920 1826 14.16 1322 10.25 80 43.81 1928 130300 1853 14.22 1290 9.90 91 49.10 1929 128300 1731 13.49 1510 11.76 100 57.77 1930 128300 1757 13.69 1222 9.52 81 46.09 1931 128600 1812 14.09 1365 10.61 71 39.18 1932 127140 1666 13.10 1341 10.54 89 53.43 1933 125700 1499 11.91 1468 11.67 76 50.70 1934 123430 1454 11.78 1317 10.67 64 44.02 1935 121690 1493 12.26 1225 10.06 60 40.18 1936 119900 1421 11.85 1272 10.61 74 52.07 1937 118100 1420 12.02 1349 11.42 75 52.81 1938 117200 1509 12.87 1148 9.79 70 46.38 B116100* 1939 D110800* 1499 12.90 1242 11.21 46 31.65 1940 96500 1353 14.02 1563 16.2 50 39.03 1941 84790 1129 13.31 1142 13.46 37 38.30 1942 86960 1452 16.69 1123 12.91 73 50.27 1943 87880 1595 18.14 1248 14.20 57 35.73 1944 85440 1613 18.87 1285 15.04 68 42.15 1945 87330 1474 16.87 1147 13.13 52 35.27 * Population as estimated for purposes of B, Birth Rate, D, Death Rate. 17 GENERAL PROVISIONS OF HEALTH SERVICES FOR THE AREA. FOOT CLINIC. Summary of Attendances and Treatment. During the year 6,035 attendances for treatment were made. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 71 1,053 1,124 Females 298 4,212 4,510 Children 67 334 401 Total 436 5,599 6,035 During the year the number of persons who received free treatment was 49 (11.2 per 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 30 300 1,037 310 1,067 Unemployed - 1 - 15 - 16 Widows - - — - - - Services 5 3 20 4 25 7 Totals 15 34 320 1,056 335 1,090 Defects Treated. Bursitis 12 Callosities 87 Corns, hard 102 Corns, soft 15 Corns, under nail 12 Hallux flexus 1 Hallux valgus 35 Metatarsalgia 24 Nails, club 27 Nails, ingrowing 34 Pes cavus 3 Pes planus 15 18 Verruca pedis 52 Hammer toe 1 Septic conditions 2 Conditions due to sprain 5 Hyperidrosis 1 Fissured heel 1 Arthritis 1 Erythema pernio 2 Incipient flat foot 2 Referred for Medical or Surgical Treatment. During the year 22 patients were referred to their own private medical practitioners for the following conditions:— Pes planus 3 Pes cavus 1 Hallux valgus 2 Hallux rigidus 2 Verruca pedis 2 Exostosis 2 Hammer toe 2 Frost bite 1 Arthritis 2 Dermatitis 1 Paralysis 1 Oedema 1 Onychocryptosis 1 Post operative pain 1 SCABIES. In order to provide facilities for dealing with the increased prevalence of scabies and verminous conditions at that time, a Special Clinic and Cleansing Centre was established in Ruckholt Road School in the early part of 1942. The following figures show the work done at that Clinic since then. Year Cases Treated Total attendances for treatment Children Adults Total 1942 (10 mths.). - - 303 1291 1943 522 632 1154 2490 1944 328 517 845 1990 1945 302 454 756 1462 19 Attendances during 1945. Number of patients treated 756 Children 302 Adults 454 Number of patients who had One routine treatment 756 Two „ „ 368 Three „ „ 103 Four „ „ 24 Five „ „ 13 Six „ „ 1 Local treatment, no bath 197 1,462 Source of New Cases:— Referred by Hospitals 45 Referred by General Medical Practitioners 307 Referred by Council's Medical Staff 146 Contacts 258 756 CIVIL AMBULANCE SERVICE. In May, 1943, the control of the Council's fleet of three motor ambulances was transferred from the National Fire Service to the Council's Emergency Committee, and on 1st October of that year the vehicles and equipment were transferred from Harrow Green Fire Station to a newly built temporary garage in Auckland Road. The vehicles were then manned by Civil Defence drivers and attendants, and continued to be so manned until the disbandment of the Civil Defence Organisation at the end of June, 1945. Thereafter the Council engaged the services of the number of drivers necessary to operate a modified service consisting of two ambulances during the day shifts, and one ambulance during the night shift. Later in the year, as more ambulance drivers became available, authority was given for the engagement of personnel sufficient to operate a 24-hour service on the lines of that in operation before the war. 20 During the period of the war the Volunteer Car Pool administered and operated by the Women's Voluntary Service fulfilled most admirably a great public need by transporting free of charge sick persons to and from hospitals and other institutions for special treatment. Having been closely associated with this aspect of W.V.S. activity, I was much impressed by the prompt, courteous and efficient manner in which they complied with all applications and requests for such transport made by my Department. After the disbandment of the W.V.S. Volunteer Car Pool at the end of July, 1945, the number of applications received for the transport of such cases showed the need for the provision of public facilities for the transport of sitting cases. As it is uneconomic to use fully equipped ambulances for patients who can be conveyed satisfactorily in sitting cars, the purchase of a sitting case car has been sanctioned. The following table gives particulars of the cases transported in Council ambulances during the year:— Accidents 375 Taken ill in street 160 Maternity 338 Attempted suicide 7 Transfers to and from Hospitals 1025 1905 The mileage covered during the year was 11,955. WATER SUPPLY. The Leyton area is supplied by the mains of the Metropolitan Water Board, whose system serves some seven million people with an average daily supply of 300 million gallons. Five-sixths of the supply is river water, which has to undergo most elaborate purification to deal with the increasing amount of pollution to which it is subjected. The remaining one-sixth, supplied from the wells of the great chalk basin beneath London, is deteriorating progressively due to increasing urbanisation; and it has to be chlorinated. Continuous and intensive examination and analysis of the water supply is carried out by the Director of Water Examination, Metropolitan Water Board. During the early days of the first London 'blitz' in September, 1940 one was appalled to see fractured water and sewage mains in bomb craters, which became filled with a mixture of drinking water 21 and sewage. Such fracture of water mains occurred during almost every heavy air raid, and the Director of Water Examination has reported that on one night alone over 500 water mains were broken. Sewers were damaged during each air raid, with the inevitable result that untreated sewage was discharged into the river from which the raw water supplies came. Reservoirs were cut off from purification works by the destruction of aqueducts. Bombs fell into filter beds and caused short circuits between filtered and unfiltered water channels. The demand for water to deal with fires necessitated the occasional by-passing of the slow sand filters in order to maintain supplies. Here, surely, were circumstances which might be calculated to cause pollution of water supplies on a scale hitherto unknown. Had the enemy succeeded in stopping or polluting the water supply of one sixth of the country's population, it would have been a staggering blow worth many military victories. However, by exercising unremitting attention and supervision, and by the application of special measures designed to shut out sewage from water channels, those in charge of London's water supplies were able to avoid a major calamity to public health and morale. Furthermore, they have achieved the wonderful record of being able to report that not a single case of typhoid fever attributable to the water supply has occurred in London since September, 1939. This is indeed one of the greatest achievements during the war; but, like so much of the work undertaken in the interests of the public health, it has never received the appreciation it deserves because it never allowed to occur the disasters it was designed to prevent. PUBLIC TRANSPORT FACILITIES. I take this opportunity of quoting a paragraph which appeared in my Annual Report for the year 1930. "Inasmuch as a very large proportion of the inhabitants work in the City and County of London, it is aptly described as a "dormitory of the Metropolis." By no stretch of the imagination can it be claimed that Leyton is well served as regards facilities for travelling by rail, and the extent of the overcrowding in the trains to and from London during 'rush hours' cannot be regarded as other than a potent factor in the spread of communicable disease. Your Council has wisely made representations to the Railway Company with a view to the provision of better facilities for the travelling 22 public, but apparently without avail. The conditions under which our City workers earn their living are often far from ideal as regards light, ventilation, noise, overcrowding, etc. Although Health Authorities and the Home Office possess statutory powers for controlling the conditions of work in factories and workshops, no such powers exist for the protection of the great body of clerical workers, etc., in the offices of the City. 'The tired City-worker' is an expression in everyday use, and there can be little doubt that the conditions of work in the City—coupled with the nervous strain associated with journeys to and from work—play a considerable part in the production of that 'tired' feeling. All City workers may not return from work bodily tired, but all tired City workers return with diminished bodily resistance against infection; and it is in this state of impaired resistance that they are compelled to run the gauntlet of massive doses of infection in dirty, stuffy and overcrowded railway compartments." Not only has there been no improvement since that time, but there has been a marked deterioration in the appalling conditions under which Leyton residents have had to travel to and from London during and since the war. I have always considered that overcrowded public transport vehicles were the most fruitful source of respiratory infection; and, until such time as travelling conditions are rendered less dangerous, there is much to be said in favour of the continuation of the war-time poster "Is your journey really necessary?" PUBLIC MORTUARY. Number of bodies deposited, death being due to:— Natural causes 57 Suicide 3 Street accidents 1 Other accidents 3 Drowning 1 Murder 1 66 Number of Post-mortem examinations performed 66 umber of Inquests held 9 23 In 57 instances no inquest was considered necessary in view of the post-mortem findings that death was due to natural causes. The causes of death in these cases were certified as follows:— Coronary thrombosis 20 ,, occlusion—atheroma 11 Hyaline necrosis of aorta 1 Aortic stenosis 1 Myocardial degeneration 3 Cerebral thrombosis 4 Broncho pneumonia 3 Asthma and empyema 1 Bronchitis 2 Pulmonary tuberculosis 2 Miliary tuberculosis 1 Intestinal obstruction 1 Strangulated hernia 1 Carcinoma of oesophagus 1 „ ,, stomach 1 Atelectasis 1 Pulmonary embolism 1 Epileptic seizure 1 H ypertension 1 Inquests. The following verdicts on Leyton residents were recorded at inquests held during the year:— Accidental. Knocked down by motor car 3 ,, ,, „ trolley bus 1 ,, „ „ motor van 1 ,, ,, ,, motor omnibus 1 Collision between lorry and omnibus 1 Multiple injuries caused by barrel falling from height 1 Asphyxia due to suffocation—face buried in pillow 1 Fall from roundabout at Fair Ground. 1 Kicked in stomach by horse 1 Fractures and falls 5 Burns 1 Drowning 1 Acute Hydrochloric poisoning 1 Inhalation of stomach contents into lung 1 24 Suicides. Acute Mercuric Biniodide poisoning 1 Carbon monoxide poisoning 2 Cut throat 2 Murder. Asphyxia from strangulation 1 Open Verdict. Found drowned 3 Natural Causes. Broncho pneumonia associated with carcinoma of oesophagus 1 Coronary atheroma 1 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 2,007 Miscellaneous inspections 611 Re-inspections 5,992 Places of entertainment 7 Schools 11 Stables 16 Urinals 129 Inspections under Rats and Mice (Destruction) Act 1,443 Visits in connection with infectious disease 335 Factories without mechanical power 7 Factories with mechanical power 125 Rag and bone dealers — Foster-mothers' premises 19 Hairdressers' premises 30 Public Houses 33 Offensive Trades 66 Piggeries 12 25 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 257 Sashcords renewed 23 Plaster repaired 208 Roofs repaired or renewed 229 Guttering repaired or renewed 186 Yards paved 5 Drains relaid or partly relaid 45 Choked drains cleared 78 New w.c. pans and traps provided 97 Sinks provided 13 W.c. cisterns repaired or renewed 142 Rain water pipes repaired or renewed 95 Vent pipes repaired or renewed 39 Sink waste pipes repaired or renewed 125 Stoves repaired or renewed 154 Coppers repaired or renewed 12 Floors repaired 135 Rooms redecorated 87 Windows, sills, etc., repaired 25 Cement work to sink waste gullies repaired 30 Miscellaneous defects remedied 252 Verminous Houses. Infested. Disinfested. Number of houses 196 196 26 Rats and Mice (Destruction) Act, 1919. Ministry of Food—Infestation Order 1943 S. R. & O. 680. Complaints received and investigated 287. Complaints according to wards :— Harrow Green 27 Cann Hall 14 Leyton 34 Leytonstone 35 Forest 37 Wanstead Slip 22 Grove Green 23 Lea Bridge 41 Centra] South 29 Central North 25 287 Inspections of premises :— Food premises 800 Other premises 643 Premises freed Approximately 200 A.R.P., Civil Defence, etc. Visits were made to the following:— Food Depots 49 Decontamination of food; demonstrations, visits, etc 4 N.A.A.F.I. Canteen 1 HOUSING. Complaints. During the year 2,007 complaints 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 756 Statutory—Housing Acts Nil Public Health Acts 108 Notices complied with—Informal 851* Statutory— Housing Acts Nil Public Health Acts 70 *This figure includes notices outstanding from previous year. 27 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 (b) With State assistance under the Housing Acts. (i) By the Local Authority:— (a) For the purposes of Part v of the Act of 1936 Nil (b) For other purposes Nil (ii) By other bodies or persons Nil I.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,007 (6) Number of inspections made for the purpose 6,604 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 84 (b) Number of inspections made for the purpose 718 (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 756 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 851 28 III.— Action under Statutory Powers during the Year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 108 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 70 (b) 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 29 Requisitioning for Families Inadequately Housed. (Ministry of Health Circular No. 2845.) Premises inspected 84 Visits made 634 Schedules of repair prepared 8 Premises repaired 25 Premises occupied 25 Landlord and Tenant (War Damage) Acts, 1939-1941. Fifty-two applications were received from owners of houses for "Certificates of fitness." Forty certificates were issued. Housing Act, 1936. Information regarding 230 houses and 22 flats was supplied in connection with the "permitted number of persons" in dwellings under the Act. INSPECTION AND SUPERVISION OF FOOD. Inspections. The following visits were made to food premises during the year:— Slaughter-houses 36 Butchers 204 Bakehouses 52 Fishmongers 84 Milk shops and dairies 154 Provision shops 465 Dining rooms 158 Greengrocers 112 Fish friers 33 Meat Depots 176 Ice cream premises 102 MILK. Dairies and Milk shops. Number of premises on register 181 (Owing to restrictions imposed by rationing, there are now only 76 premises from which milk is sold.) Premises added to register during year Nil Premises removed from register during year 2 Visits of inspection 154 30 Bacteriological Examinations. Designated Milk. Licenses. No. Granted. No. of Samples taken. Result. Phosphatase Reaction. Methylene Blue Test. Satisfactory. Unsat. Satisfactory. Unsat. Tuberculin Tested 8 — — — — — Accredited 2 — — — — — Pasteurised 19 9 9 — 1 8 Supplementary Licences - - - - - - Tuberculin Tested 2 — — — — — Pasteurised 3 — — — — — Totals 34 9 9 — 1 8 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1945 67 Premises registered during 1945 Nil Premises removed from Register during 1945 Nil MEAT. Slaughter - Houses.— There are six licensed slaughterhouses in the Borough, and 36 inspections of these slaughterhouses were made. Meat and Foods condemned and destroyed. Bacon 1,393 lbs. Other meat 8,149 „ Fish 1,207 „ Fats 223 „ Cheese 153 „ Sugar 138 Dried Fruit 1,366 „ Tea 174 „ Sweets 216 „ Chocolate 144 bars Eggs 3,150 Pickles, vinegar, etc 170 bottles Jam and marmalade 2,034 lbs. Flour, rice and oatmeal 2,613 „ Tinned foods 2,853 tins Oranges.., 737 Meat Cubes 917 Miscellaneous foods 430 packets 31 Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 6 Dairies, Milk shops and Dairymen 181 Butchers' shops, Stalls and Provision shops 291 Hairdressers' Premises 52 Fish friers 17 Offensive Trades. Rag and Bone dealers 3 Tripe boiler 1 Contagious Diseases of Animals Acts and Orders. It was not found necessary to issue any orders during the year. Cattle Pens, Temple Mills Railway Siding. These pens were kept under observation during the year. One case of cruelty to a horse was reported to the National Society for the Prevention of Cruelty to Animals. 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 67. Samples analysed. Samples unsatisfactory. Milk 19 — Milk, condensed 2 — Baking powder 1 — Pepper 3 — Cough cure 1 — Celery salt 1 — Cinnamon 1 — Cocoa 1 — Gelatine 3 — Herbs 1 — Jelly dessert 2 — 32  Samples analysed. Samples unsatisfactory. Junket rennet 1 - Sausages 2 - Table dessert 2 — Vinegar 4 - Yeast and beef extract 1 - Campden tablets 1 - Fruit sauce 2 - Golden raising powder 1 - Ice cream 2 - Margarine 3 — Meat paste 1 - Bicarbonate of soda 2 - Butter 1 - Ice cream mix 1 - Jelly crystals 1 - Manucol 1 - Spice 1 - Sponge pudding 1 - Vi-tic 1 — Perry wine 1 1 Backdrops 1 - Bismuth of Magnesia 1 - 67 1 33 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)[/##3] Factories with mechanical power 125 2 Factories without mechanical power 7 - - Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) - - - Total 132 2 - 2. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) Lack of cleanliness — — Sanitary Conveniences:— Insufficient 1 Dirty - - - Other Offences - - - Total 1 - - OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937.) Nature of Work. Instances. Notices served. Prosecutions (1) (2) (3) (4) Nil Nil Nil - 34 MATERNITY AND CHILD WELFARE. INFANT WELFARE. Notification of Births.— Fourteen hundred and twentythree notifications of births were received during the year. By medical practitioners 336 By midwives 1,087 By parents and others — During the year under review, the total attendances at the Council's Infant Welfare Centres were 13,575, an increase of 2,522 compared with the figure (11,053) for the previous year. The number of children examined by the Clinic Medical Officers was 4,254 as compared with 3,758 examined during the previous year. Health Visitors. During the year the Health Visitors have made 16,088 visits to homes, as follows:— (а) To expectant mothers:— First visits 204 Total visits 224 (б) To children under 1 year of age:— First visits 1,547 Total visits 7,935 (c) To children between the ages of 1 and 5 years:— Total visits 7,929 35 TABLE 7. ATTENDANCES, EXAMINATIONS, etc., 1945. Leyton Green. Park House. All Centres. Under 1 year— 1st attendances 532 607 1,139 Subsequent attendances 4,612 4,554 9,166 Total attendances 5,144 5,161 10,305 1-5 years— 1st attendances 88 82 170 Subsequent attendances 1,519 1,581 3,100 Total attendances 1,607 1,663 3,270 Total attendances, both age groups 6,751 6,824 13,575 Average attendance per session 63.87 64.36 64.12 Number examined by clinic doctor 2,090 2,164 4,254 Number weighed 6,702 6,842 13,544 36 Dental Treatment. Expectant Mothers. Children Patients treated 109 101 Attendances 334 195 Extractions 594 284 Fillings 86 56 Other dental operations 130 15 Advice only 66 66 Anaesthetics— General 97 85 Local 84 5 Dentures supplied— Full upper and lower 13 Full upper 5 Full upper and partial lower 6 Partial upper 3 Partial upper and lower 2 29 Orthopaedic Treatment. Primary Examinations.—During the year 10 children were referred from the Infant Welfare Clinics to the Council's Orthopaedic Surgeon. Re-examinations.—In addition to the 10 new cases mentioned above, 23 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—Sixty-four children made 440 attendances for special treatment by the Council's Masseuse (Miss Findlay). Provision of Surgical Appliances.—Thirty-one children were supplied with surgical appliances on the recommendation of the Orthopaedic Surgeon. 37 Special Eye Clinic. The Council's Ophthalmic Surgeon had referred by the Clinic Medical Officers 112 pre - school children, who made 147 attendances for examination and treatment. Artificial Sunlight Treatment. Number of cases treated 86 Total number of attendances 1,548 Convalescent Home Treatment. Children. Five 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 8 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. 1 1 - 1 - — — 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 two five-year periods (a) the five years preceding the war; and (b) the last five war years. Year. Births. Deaths under Mortality Rate. Stillbirths. No. Rate per 1000 (live and still) Births. 1 year. 4 weeks. Infantile. Neonatal. (a) 1934 1,454 64 38 44.02 26.13 46 31.63 1935 1,493 60 31 40.18 20.76 44 29.47 1936 1,421 74 38 52.07 26.74 44 30.03 1937 1.420 75 37 52.81 26.05 60 40.54 1938 1,509 70 43 46.38 28.56 41 26.45 (b) 1941 1,129 37 20 38.30 20.70 31 26.72 1942 1,452 73 43 50.27 29.61 49 32.64 1943 1,595 57 36 35.73 22.57 38 23.27 1944 1,613 68 31 42.15 19.21 54 32.39 1945 1,474 52 26 35.27 17.63 34 22.54 38 TABLE a Infantile Mortality, Year 1945—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 ... ... ... ... ... ... ... ... ... ... Chicken pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... • • • ... ... Scarlet fever ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... • • • ... 1 Diphtheria and croup ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... 1 Tuberculous meningitis ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... 1 ... 1 Meningitis (not tuberculous) ... ... ... ... ... ... ... • • • ... • • • Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... • • • Bronchitis ... ... ... ... ... 1 2 1 ... 4 Pneumonia (all forms) ... ... ... ... ... 5 2 1 ... 10 Diarrhoea ... ... ... ... ... • • • ... ... ... ... Enteritis ... ... ... ... ... 2 ... • • • ... 2 Gastritis ... ... ... ... ... ... ... • • • ... ... Syphilis ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... • • • ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... Injury at birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis 8 1 ... ... 9 ... ... ... ... 9 Congenital malformations 2 1 ... ... 3 1 ... 1 ... 5 Premature birth 4 ...... ... ... 4 1 ... • • • ... 5 Atrophy, debility and marasmus ...... ... ... ... •... • • • ... • • • ... • • • Other causes 4 ...... ... ... 4 3 ... 2 1 10 Totals 22 3 ...... 1 26 13 5 6 2 52 Nett Births registered during Legitimate 1,379 Nett Deaths registered during Legitimate infants 46 the calendar year Illegitimate 95 the calendar year Illegitimate infants 6 39 TABLE 9. Infantile Mortality During the Year 1945—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 ... ... ... ... ... ... ... ... ... ... ... ... Chicken pox ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... 1 ... ... 1 Diphtheria and croup ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... 1 Tuberculous meningitis ... ... ... ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... ... 1 Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... ... 2 ... 1 ... ... ... 4 Pneumonia (all forms) ... 2 ... ... ... 1 ... 2 1 ... ... 10 Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... ... ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth ... 1 ... ... ... ... ... ... 1 ... ... 4 Atelectasis ... 2 ... ... 1 ... 1 ... 1 ... ... 9 Congenital malformations ... 1 ... ... 1 1 1 ... 1 ... ... 5 Premature birth ... ... ... ... 1 2 1 ... 1 ... ... 5 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... ... ... Other causes ... 2 2 1 1 1 1 1 ... 1 ... 10 Totals 5 9 3 2 5 7 6 5 6 4 ... 52 40 The Care of Premature Infants—Ministry of Health Circular 20/44. Report by Dr. Menzies. Special care to premature infants has been continued during 1945. The importance of this was stressed in February, 1943, when detailed instructions on the feeding and care of premature infants and twins were issued to midwives. At the same time midwives were supplied with thermometers for taking sub-normal temperatures, and with electric heating pads for use in selected cases. Mucus catheters had been part of their normal equipment for a number of years. In March, 1944, Circular 20/44 of the Ministry of Health drew the attention of Local Authorities to the need for special care for premature babies, and brought certain recommendations on providing this care to their notice. As far as is practicable these recommendations have been followed. The question of the transport to hospital of small premature babies born at home, so that they may be nursed in hospital, is secondary to the provision in hospital of adequate accommodation and nursing for such babies. At the moment this is not available. Out of a total of 1,423 notified births, there were 39 premature births in hospital and 21 at home, plus a case of premature twins born to an unmarried woman who gave an address in Leyton. This girl had been living in the Borough for only three weeks and did not return after the birth as far as could be discovered. The pregnancy terminated at 30 weeks and both twins died within twenty-four hours. It seemed doubtful whether the deaths should have been credited to Leyton, but it was impossible to obtain information which would have led to more accurate registration. Of the 21 premature babies born to Leyton women in their own homes, only one death occurred, and that was in the first 24 hours. All except three weighed 4 lb. or more at birth. The three between 3—4 lbs. were of twin pregnancies, and all survived. The small proportion of deaths is evidence that the care taken of these premature babies was adequate, and a large share of the success must go to the mothers. The nursing of premature babies demands continuous care and very gentle handling, and in domiciliary births (without a resident nurse) it is impossible for the children to survive without the intelligent co-operation of the mother. It is satisfactory, too, that the only babies weighing less than 4 lbs. were three from twin pregnancies, and that there were none weighing less than 3 lbs. This suggests that the health 41 of the mothers of these babies is on the whole good as the more serious maternal conditions give greater degrees of prematurity and lower birth weights. It is not possible to give such complete information about the 39 premature births which took place in hospitals outside the district, but it is known that there were 10 deaths in the first twenty-four hours, 3 of whom were in cases of toxaemia of pregnancy and a fourth was of a twin pregnancy. An eleventh death took place after a week, the baby being severely jaundiced ; and there was a twelfth death at six weeks from broncho-pneumonia. The total number of deaths at home and in hospital from these 60 premature live births was 13; and, as 11 of these occurred in the first twenty-four hours (10 in hospital), it is evident that the reduction of such deaths will depend mainly on increasing knowledge of the cause of the premature births. The only death which could possibly have been avoided by .better 'child welfare,' as opposed to 'maternal welfare,' was the death from broncho pneumonia at six weeks. This total of deaths from prematurity includes all deaths where it was known that the baby was premature according to the accepted definition of prematurity, i.e. an infant weighing 5½ lbs. or less at birth. In the Registrar General's table of infant deaths a proportion of these deaths of premature infants are classified under atelectasis. Public Health Act, 1936. Child Life Protection. On 1st January, 9 foster mothers and 9 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 45 visits of inspection during the year. Summary, Year 1945. Number of nurae children on Register, 1st January 9 Number of nurse children notified by foster mothers during the year 11 Nurse children removed :— To parents or relatives 4 Adopted 1 To institutions 1 Attained 9 years of age 2 Died 1 Number of nurse children on Register on 31st December 11 42 MATERNAL WELFARE. Ante-Natal Clinics— Attendances.— First Subsequent Attendances. Attendances. Total. 544 940 1,484 The average number in attendance at the Ante-Natal Clinics held at the Council's two Centres during 1945 was 10.23 per session. The number of home visits made by Health Visitors to expectant mothers during the year was 224. Maternity Beds. Six hundred and thirty patients were admitted during 1945 under the terms of the agreements with Mothers' Hospital, Clapton, Queen Mary's Hospital, Stratford, and Forest Gate Hospital. Public Health Act, 1936. Registration of Nursing Homes. There are two registered nursing homes in the Borough. Nine inspections were made to these institutions during the year. Home Helps. Under the Council's scheme for the provision of home helps, 181 applications, 16 of whom made application in 1944, for home helps were dealt with. In 131 cases home helps were provided and 27 of these cases had the charges remitted in accordance with the Council's scale. In the 50 remaining cases, 14 made other arrangements for the confinement, and 36 cases had not been confined at the end of the year. Puerperal Pyrexia. Seven cases of puerperal pyrexia were notified during the year. The causes of pyrexia were considered to be:— Local uterine infection 1 Broncho-pneumonia 1 Not known 1 Influenza 1 Pyelitis 1 Abortion 2 7 43 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. Eighty-five such notifications were received. Fees paid to Doctors. One hundred and seventy-one accounts were received from general medical practitioners for assistance rendered to midwives under the provisions of the Medical Practitioners (Fees) Regulations, 1936. The total amount paid to medical practitioners during the year was £279 9s. 6d. Post-Natal and Gynaecological Clinic. Leyton Green Health Centre. Number of Sessions 14 Letters of Invitation 175 First Attendances 116 Re-attendances 93 Report by Dr. 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 116, out of 175 who received appointments to attend (= 66 per cent.). Of these, 76 were post-natal (i.e., they had had confinements within the previous three months); and 40 were gynaecological. The disposal of these cases was as follows:— Discharged after one attendance 45 Re-attended for examination and treatment 71 44 The total number of attendances was 209. The average attendance per session was 15.50—with a maximum of 20 and a minimum of 9. Free medical prescriptions were issued in 63 cases at a total cost of £8 Is. 5d.; and 29 prescriptions were issued for payment by the patients. The following are the main conditions which have been found on examination :— Prolapse of the uterus 1 Subinvolution of the uterus 13 Cystocele and rectocele 3 Retroversion of the uterus 11 Anaemia 6 Defective perineum 1 Cervical erosion 3 Inflamed adnexa 2 Vaginitis 5 Ovarian cyst 1 Fibroid 1 Birth control 27 Record of Cases attended by Council Midwives, 1945. Midwives employed by Total Council E.C.N.A. 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. Cases attended:— (a) As Midwives 155 286 441 (6) As Maternity Nurses 27 41 68 Ante-natal Visits 498 1,842 2,340 Ante-natal Examinations 1,318 2,664 3,982 Post-natal Visits 3,442 7,010 10,452 45 Gas and Air Analgesia. In June, 1945 the Medical Officer of Health was asked by the Welfare Authority to report on the question of the institution of facilities for the administration of gas and air analgesia by midwives; and the following is an extract from the report submitted the following month:— Prior to 1942 Rule 10 of the Central Midwives Board stated that— (a) A midwife must not, except under a grave emergency, undertake operative procedure or any treatment which is outside her province. (b) A midwife must not on her own responsibility use any drug unless, in the course of her obstetric training, whether before or after enrolment, she has been thoroughly instructed in its use and is familiar with its dosage and methods of administration or application. On 10th October, 1942 the Central Midwives' Board issued the following modification of the above rule:— "In the application of Rules E.10 (a) and (b) the Board regards the administration by a midwife, acting as such, of gas and air by Minnitt's or similar apparatus for the purpose of producing analgesia during labour as treatment within her province, provided that — 1. She has, either before or after enrolment, received at an institution approved by the Board for the purpose, special instruction in the essentials of obstetric analgesia and has satisfied the institution that she is thoroughly proficient in the use of the apparatus ; 2. The patient has within one month before her confinement been examined by a registered medical practitioner who has handed to the midwife a certificate in writing that the patient is in a fit condition for gas and air administration; and 3. One other person being one or other of the following (a) a state certified midwife, or (b) a state registered nurse, or 46 (c) a senior medical student, or (d) a pupil-midwife, or (e) a retired midwife who has surrendered her certificate in accordance with Section 5(1) of the Midwaves' Act, 1936, or (f) a woman who is over 21 years of age and who is, and has been for at least a year (i) a V.A.D. or ordinary member of the British Red Cross Society and the Order of St. John, or (ii) a whole-time member or part-time auxiliary of the Civil Nursing Reserve is present at the time of administration in addition to the midwife in charge of the case. Administration by a midwife of any anaesthetic, otherwise than under the personal direction and supervision of a registered medical practitioner, is regarded as treatment outside her province." Copies of the amended Rule were issued to the midwives practising in Leyton. Under Sec. 7 of the Midwives, Act, 1936 it became the responsibility of every Authority to provide or arrange for the provision of "Refresher" courses for midwives practising in its area. Except in special circumstances midwives were required to undergo such courses at intervals of not more than 5 years. In January, 1939 I communicated with the Plaistow Maternity Hospital, which had been approved by the Central Midwives Board for the purpose of conducting such courses, and I had planned to send the Leyton midwives to attend these courses in turn. Before arrangements were finally made, Section 7 of the Midwives, Act, 1936 was withdrawn owing to the national emergency and the impossibility of holding "Refresher" courses. I am now informed by the Central Midwives Board that arrangements for the courses to be resumed are under consideration by the Board, and approved institutions will be notified when the courses may recommence. 47 Most of the midwives employed by the Essex County Nursing Association have already taken the approved course of instruction. Only three are not qualified to administer gas and air, but it would presumably be desirable that all the midwives practising in the Borough should attend a course of instruction. When the question of the actual administration of gas and air analgesia arises, some arrangement will require to be made by which two midwives, or a midwife and a pupil, are available for each case desiring analgesia. In the report on 'A National Maternity Service' prepared in 1944 by a Committee on behalf of the Council of the Royal College of Obstetricians and Gynaecologists there is a section on the relief of pain. The report states that it is the duty of the medical attendant and midwife to relieve the pain of labour as thoroughly as possible, bearing in mind that their efforts in this direction must not be allowed to jeopardise the safety of the mother or child. The concluding paragraph reads: "We would stress that much more thorough and varied training than has hitherto been given is necessary for doctors and midwives, within their respective scopes, in the methods and drugs used for relieving the pain of labour; for we have no doubt that the widespread use of anaesthetics and analgesics by unskilled administrators results in maternal and neonatal deaths and stillbirths." The cost of the apparatus for the administration of gas and air analgesia (weighing some 28 lbs.) is £26 10s. 0d. A further amendment of Rule 10, Sec. 3, was made by the Central Midwives Board in September, 1945. This section refers to the second person who must be present at the time of administration of gas and air analgesia by the midwife in charge of the case. The section now reads:— "One other person, being any person acceptable to the patient, who in the opinion of the midwife is suitable for the purpose, is present at the time of the administration in addition to the midwife in charge of the case." so that it is no longer necessary for this second person to have had any training. 48 After consideration of that report the Maternity and Child Welfare Authority agreed to the suggested arrangements for the training of the Council's midwives and for the purchase of the necessary apparatus. One of the municipal midwives attended a course of instruction in December, and it is hoped to arrange for the training of all Council midwives as soon as conditions permit. WAR-TIME DAY NURSERIES. The two war-time Day Nurseries, established in 1942, have continued in operation during the year under review. Each nursery is designed, equipped and staffed to accommodate 50 children; and the table appearing on page 49 gives full details of the monthly attendances of children in the two age groups (under two years; and between two and five years). Ellingham Road. During the night of 16th-17th February this nursery was very severely damaged by enemy action, and it was not until 11th June that war-damage repairs had been completed sufficiently to allow of the nursery being re-opened for the reception of children. As a result of prompt action by the Medical Officer of Health, West Ham, it was possible to arrange for the disposal of children and staff in West Ham nurseries during the time Ellingham Road nursery was unfit for occupation. CD TABLE No. 10. WAR-TIME DAY NURSERIES — AVERAGE DAILY ATTENDANCE, 1945. 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 8.39 29.39 2.25 8.25 37.78 10.50 6.43 19.34 2.50 7.25 25.77 9.75 February 11.15 34.10 4.50 9.25 45.25 13.75 8.41 20.08 3.50 7.00 28.49 10.50 March 13.09 31.14 5.50 11.50 44.23 17.00 Closed from 17.2.45 to 10.6. 45 owing to dam age by enemy action. April 14.40 27.95 6.50 6.75 42.35 13.25 May 13.50 34.45 5.00 11.66 47.95 16.66 June 11.52 33.61 4.40 11.00 45.13 15.40 9.20 25.40 4.00 15.33 34.60 19.33 July 12.09 33.45 4.75 8.75 45.54 13.50 13.18 33.13 4.25 13.50 46.31 17.75 August 11.40 30.30 4.00 10.66 41.70 14.66 14.50 31.95 8.33 12.33 46.45 20.66 September 11.60 30.25 3.40 10.20 41.85 13.60 15.35 32.90 8.20 13.80 48.25 22.00 October 10.65 34.65 4.00 11.25 45.30 15.25 15.17 34.86 5.50 11.00 50.03 16.50 November 11.45 31.63 4.75 11.00 43.08 15.75 12.72 35.54 5.50 8.75 48.26 14.25 December 8.22 23.11 2.75 8.25 31.33 11.00 10.94 24.44 3.00 5.25 35.38 8.25 Average for Year 11.45 31.16 4.31 9.87 42.61 14.18 11.76 28.62 4.97 10.46 40.38 15.43 50 Analysis of Withdrawals. In 1943 I submitted a special report (later published in my Annual Report for that year) showing the actual period of attendance at the Day Nurseries of the 152 children who had been withdrawn since the nurseries opened (i.e. over a period of one year). The periods during which these children attended were:— Less than 1 week 48 children ,, „ 4 weeks 36 „ ,, ,, 8 weeks 27 „ More than 8 weeks 41 152 It has now been possible to collect similar information regarding the 368 children who have been withdrawn since the nurseries opened. Of these 368 children, only 60 remained at the nurseries until they went to school, leaving 308 who were withdrawn before they were due to attend school. The following figures show the periods of attendance of these 308 children:— Less than 1 week 54 children „ ,, 4 weeks 47 ,, ,, 6 months 121 More than 6 months 86 308 By comparing these two sets of figures (of which the first set is included in the second) it will be seen that the great majority of early withdrawals (under four weeks) occurred during the first year of the nurseries' existence. With regard to the early withdrawal of children, which is disappointing from an administrative point of view, it has been the experience of your medical and nursing staff that the mothers who submitted the most urgent appeals for the immediate admission of their children were generally those who withdrew their children in the shortest time after admission. 51 Nursery Dietaries. In February, 1943 the Chief Medical Officer, Ministry of Health, had occasion to address a letter to Medical Officers of Health of Welfare Authorities drawing attention to the ascertained fact that the nutritional condition, particularly of children in the 1-2 age group of nursery children was not as good as it should be; and this he considered to be somewhat disturbing in view of the fact that extra rations and special vitamins were available for these children. Medical Officers were therefore advised to review the nursery dietaries. In Leyton, at the time the nurseries were opened, the question of adequate dietaries was considered very carefully by Dr. Menzies and the Matrons. Since that time there has been available for each child not only cod liver oil and fruit juice daily, but suitable preparations containing iron have been administered to each child who was considered to require them. These facts regarding available dietaries should be considered in association with the observations made by Dr. Menzies at the end of this report. Progress made by Children attending Day Nurseries Recently there has been much controversy regarding the progress made by children attending day nurseries. There are those who state that children attending day nurseries make better progress than children cared for at home. On the other hand, there is a growing body of medical opinion which considers that children (especially those under two years of age) make much better progress at home, where they are not exposed to infectious disease in massive doses at so early an age. Unfortunately, the amount of evidence adduced so far is surprisingly small, and most of it is far from being of much scientific value. The only satisfactory way to conduct a proper investigation of this kind would be for accurate records to be kept of— (a) a number of children attending a day nursery, and (b) an equal number of comparative children kept at home ; and, in order to narrow the margin of error as much as possible, it would be necessary for the same observers to investigate the progress of as many children as possible in each group over as long a period as possible. Unfortunately war-time day nurseries were established when the depleted staffs of health departments were fully occupied in 52 endeavouring to carry out the many extra duties connected with the war effort, and there is no record of any investigation on these lines having been carried out. Although a trained observer can form a reliable estimate of the nourishment or malnourishment of a child in many ways, such findings are never more than expressions of opinion ; and the only ' yardstick ' available at the present time for the assessment of health in young children is gain in weight. Report of Dr. Menzies. The most striking fact has been the rapid turn-over of children. In theory one would have expected that with certain exceptions (e.g. the mother becoming pregnant) a child admitted to a day nursery would have remained at the nursery until he went to school. The majority of children who left within four weeks were considered by their mothers to be "fretting," and after going over the records of those children under two years who remained in the nurseries over three months I think it is possible they made a wise decision in withdrawing them. Seventy-six left within three months. Thus, of 32 children who were admitted in their first year and stayed more than three months, eight gained 0-8 oz. in weight in the first three months in the nursery, and another seven gained 8-16 oz. An average gain at this age is 1 lb. per month. The following table shows the gain in weight in the first three months, in the second three months, and in the first twelve months of two groups in each nursery (those admitted when they were between 12-18 months, and those admitted when they were between 18 months and 2 years). Besides showing the average gain in weight in each group over the period stated, I have indicated the number of children in each group on which the gain in weight is calculated. It is obvious that the number who remained in the nurseries over twelve months are a definitely selected group, and the number in each age group is too small to form any definite conclusions. The average gain in weight of children between 1-2 years is 5-7 lbs., so that these gains appear to be at the lower limit of normality. 53 Gain in weight during stay in Nursery. Age on Admission. 0-3 months. 3-6 months. 0-12 months. Nursery A 12-18 months Aggregate Gain 25 lb. 14 oz. 23 lb. 6 oz. 48 Ib. No. of Children 26 20 9 Average Gain 1 lb. 1.17 Ib. 5.3 lb. Nursery B 12-18 months Aggregate Gain 45 lb. 24 lb. 8 oz. 82 Ib. No. of Children 32 24 16 Average Gain 1.4 1b. 1.34 Ib. 5.12 Ib. Nursery A 18-24 months Aggregate Gain 22 lb. 6 oz. 10 Ib. 13 oz. 12 lb. l4oz. No. of Children 15 10 3 Average Gain ... 1.49 Ib. 1.081b. 4.29 lb. Nursery B 18-24 months Aggregate Gain 25 lb. 15 oz. 27 lb. 5 oz. 551b. No. of Children 27 20 11 Average Gain 96 lb. 1.38 lb. 5 lb. So far I have only attempted to review the progress of children who were admitted to a nursery before they reached the age of two years. I have done so because there is most controversy over the wisdom of admitting children as young as this to a nursery. They are not then old enough to benefit from association with other children, and there are certain obvious risks, namely, fretting because of separation from the mother, and infections. In spite of the extra rations and supplementary medicaments available, I have never been satisfied with the progress of these young children. From the point of view of the welfare of the child I should therefore only be prepared to recommend the admission of a child under two years if there was very definite evidence of neglect or mismanagement of the child in the home. I have a record of one child, who was suffering from chronic malnutrition and neglect, and has done very well in the nursery. 54 To take the average gain conceals the progress of individual children ; but of those admitted between 12-18 months, three lost weight in the first three months, nine gained 0-8 oz., and an additional nine gained less than 1 lb. This was out of a total of 58 children. Thus over one third made unsatisfactory progress in the first three months. In the second three months two children lost weight, five gained 0-8 oz., and four gained less than 1 lb. The total number of children here was 44, so one quarter made unsatisfactory progress in the second three months. Of 42 children admitted between 18 months and 2 years, seven lost weight, three gained 0-8 oz., and five gained less than 1 lb. in their first three months in the nursery—again one third whose gain was unsatisfactory. In the second three months two children lost weight, six gained 0-8 oz., and three gained less than 1 lb., out of 30 children. As children in nurseries are in a very favoured position as regards rations compared with children whose mothers are looking after them at home, I can only regard the progress of these groups of children admitted under two years as disappointing. It is reasonable to suppose that illnesses accounted for the poor gains to some extent, but this cannot be the complete explanation, as some children had as many as four infections, and did satisfactorily ; whereas others had no illness and yet did badly. The number of children admitted under two years who developed infections in the nurseries is high. At Ellingham Road 35 children out of 60 who remained over three months in the nursery had one or more infections, and at Knotts Green 54 children out of 72. The commonest infections were of the catarrhal type— measles, whooping cough, german measles and pneumonia, but scarlet fever, mumps, dysentery, jaundice and chicken pox all occurred. I included acute bronchitis only if it resulted in several weeks absence from the nursery. Some children had as many as four infectious diseases, and of 60 children (including the admissions under 12 months) who remained twelve months or over, only seven escaped infection. It has been suggested that places might be kept in the nurseries for the children of mothers who are ill or who are pregnant. So far we have usually found that if a mother is ill, she does not send her 55 child to the nursery. If the mother is seriously ill, day nursery provision is not adequate, and in any ease someone would have to be available to bring the child to and from the nursery. A scheme of domestic helps would be more serviceable for both these groups of mothers. If places were to be kept for children who were only intended to be in the nursery for three months or less I would suggest that they should be in the over two years age group, at which age the child settles more readily without emotional disturbance, derives benefit from contact with other children, and an infection is a less serious matter. In the new training scheme for nursery nurses a suggestion is made that experience in handling babies under six months should be gained in the homes. DOMESTIC HELP SCHEME. Ministry of Health Circular 179/44 (Dec., 1944) expressed the concern of the Government regarding the need for supplying domestic help to persons sick and infirm (whether through old age or otherwise), and extended the power of local authorities to provide such help in necessitous cases other than mothers and young children, in whose case the Welfare Authority already had power to supply domestic help. In the event of an authority being satisfied that there was a need for such an extended service of domestic helps in their area, the Circular recommended that application be made to the Ministry of Labour and National Service, and that the authority should themselves employ the helpers at rates of pay not less than those of the Hetherington scale. In January, 1945 the Council adopted the scheme, and applica tion was made to the Ministry of Labour Employment Exchange for women to undertake the work. As no women had been referred by the Ministry of Labour and National Service by the month of July, application was made to the Ministry of Health to find out whether the Ministry would sanction the Council accepting, for the extended service, the services of domestic helps provided by applicants themselves as is done in the case of home helps supplied by the Welfare Authority ; but the necessary sanction had not been obtained by the end of the year. 56 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 occurred in the area. CEREBRO-SPINAL MENINGITIS. 4 cases were notified during the year. MEASLES. 797 cases of measles were notified during the year. WHOOPING COUGH. 99 cases of whooping cough were notified during the year. SCARLET FEVER. Year. Cases Notified. Deaths. Case Fatality per cent. 1941 64 1 1.56 1942 318 0 0.00 1943 386 0 0.00 1944 110 0 0.00 1945 312 0 0.00 DIPHTHERIA. Year. Cases Notified. Deaths. Case Fatality per cent. 1941 44 1 2.27 1942 39 0 0.00 1943 28 1 3.57 1944 24 1 4.16 1945 43 2 4.6 ARTIFICIAL IMMUNISATION AGAINST DIPHTHERIA. Immunisation by Private Medical Practitioners. Number of private medical practitioners who applied for supplies of toxoid- antitoxin 15 Number of children immunised 49 Municipal Clinic. 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. 57 RETURN FOR THE YEAR 1945. Age 0-5 years. Age 5-15 years. Total. 1. Number of Children who completed the course of immunisation during the year 1,242 89 1,331 2. (a) Approximate estimated child population at end of year 6,860 10,940 (6) Percentage of child population considered to be immunised at end of year 48.16 73.70 Incidence of Diphtheria Among Protected Persons. During 1945 eight 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. 14 F 40 6.4.45 T Not diphtheria. 9 F 21.10.37 18.7.45 — Scarlet fever. 3 F 15.9.43 25.8.45 — Tonsillitis. 12 F 24.6.43 5.10.45 T Vincents Angina. 11 M 16.5.45 2.11.45 — Not diphtheria. 5 M 13.1.42 12.11.45 T ,, ,, 13 M 18.7.35 4.12.45 — ,, ,, 4 M 21.12.42 12.12.45 T N Vincents Angina. 7 F 24.6.43 3.6.45 - Diphtheria. TUBERCULOSIS. Notifications.— One hundred and twenty-two patients were notified for the first time in 1945 as suffering from tuberculosis. The number was made up as follows :— Males. Females. Total. Pulmonary Tuberculosis 71 40 111 Non-Pulmonary Tuberculosis 6 5 11 77 45 122 58 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1945:— Pulmonary. Non-Pulmonary. total M. F. Total. M. F. Total. Number on Register at commencement of year 287 208 495 37 42 79 574 Number first notified during the year 71 40 111 6 5 11 122 Number of cases entered in Register otherwise than by Notification 7 20 27 5 1 6 33 Number removed from the Register during the year 40 34 74 12 3 15 89 Number remaining at the end of the year 325 234 559 36 45 81 640 Details of cases removed from the Register during the year:— Died 20 18 38 5 2 7 45 Removed from the district 19 15 34 5 — 5 39 De-notified 1 1 2 2 1 3 5 Deaths.— Forty-one deaths from tuberculosis were recorded. The following table gives particulars regarding the new cases which have occurred during the year:— Age Periods. New Cases. Pulmonary. Non-Pulmonary. M. F. M. F. 0 - - - - 1 — 1 2 1 5 1 — — — 10 1 - - 2 15 5 8 2 1 20 12 10 — 1 25 18 11 1 — 35 14 7 — - 45 10 1 - - 55 7 1 - - 65 and upwards 3 1 1 — Totals 71 40 6 5 59 Institutional Treatment. During 1945 the following Ley ton patients were sent to sanatoria or other institutions for the treatment of Tuberculosis:— Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. Adults 40 29 4 2 75 Children 1 1 2 1 5 60 TABLE No. 11. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1945. DISEASE. At At.l Aqes 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 43 1 3 2 3 2 11 8 6 6 ... 1 ... Erysipelas 14 ... ... ... ... ... ... ... ... 3 4 2 5 Scarlet Fever 312 1 8 17 14 33 152 54 14 10 7 2 ... Pemphigus Neon. 1 I ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 111 ... ... 1 ... ... 1 1 13 51 21 19 4 T.B. Others 11 ... ... ... 1 2 ... 2 3 2 ... ... 1 Pneumonia 44 2 3 1 2 2 i 3 1 3 10 10 6 Ophthalmia Neon. I 1 ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 1 ... ... ... ... ... ... ... ... ... 1 ... ... Puerperal Pyrexia 7 ... ... ... ... ... ... ... ... 4 3 ... ... Cerebrospinal Meningitis 4 ... ... ... 1 1 1 ... ... 1 ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 26 3 6 ... 2 ... 3 3 ... 5 2 2 ... Measles 797 35 81 88 99 98 369 20 2 5 ... ... ... Whooping Cough 99 16 17 6 17 12 26 2 ... 2 ... 1 ... Malaria 2 ... ... ... ... ... ... 1 1 ... ... ... ... Totals 1,473 60 118 115 139 150 564 94 40 92 48 37 16 <31 H- TABLE 12. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAH 1945. DISEASE. Total. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 43 1 6 4 3 3 4 2 8 7 5 43 Erysipelas 14 1 3 ... 6 1 1 ... 1 ... 1 1 Scarlet Fever 312 19 57 19 29 83 29 29 29 ii 7 140 Pemphigus Neon. 1 ... ... ... ... ... ... 1 ... ... ... ... Pulmonary T.B. 111 9 21 7 10 14 14 6 10 14 6 ... T.B. Others 11 1 3 1 ... 2 1 1 ... 1 1 ... Pneumonia 44 1 14 2 4 13 2 1 2 1 4 6 Ophthalmia Neon. 1 ... ... ... ... ... ... 1 ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 1 ... ... ... ... ... 1 ... ... ... ... 1 Puerperal Pyrexia 7 1 2 ... ... 3 1 ... ... ... ... 7 Cerebrospinal Meningitis 4 ... 1 ... 1 2 ... ... ... ... ... 3 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 26 ... 5 1 8 7 4 1 ... ... ... 20 Measles 797 31 135 61 110 140 79 53 74 64 50 26 Whooping Cough 99 16 19 15 20 11 6 ... 7 3 2 16 Malaria 2 ... ... ... ... 2 ... ... ... ... ... 2 Totals 1,473 80 266 110 191 281 142 95 131 101 76 265 62 SCHOOL MEDICAL SERVICE. GOVERNMENT EVACUATION SCHEME. Numbers of children evacuated during:— Accompanied. Unaccompanied. Medical Examination. 1. September, 1938 Nil Nil Nil 2. September, 1939 5,930 (including mothers) 5,985 Nil 3. The Flying Bomb & Rocket menace— (a) Officially 2.231 1,000 3,231 (6) Privately 3,789 878 Nil School Population and Attendance. On 2nd May, 1945 the signal was given by the Ministry of Health for the commencement of the operation of the plan for returning to the Borough persons evacuated under the Government Evacuation Scheme, and the operation was completed by the following July. It is therefore now possible to resume the submission of information regarding school population and attendances in the form in which it was presented before the war; and the figures set out below relate to the financial year ended 31st March, 1946. Number Roll Average Attendance Percentage of Attendance 1. Secondary (Modern) Schools Boys' 5 998 901 90 Girls' 5 930 826 80 Mixed 2 594 525 88 2. Primary Schools Mixed 12 3,786 3,397 90 Infants' 15 2,876 2,404 83 R.C. (Mixed and Infants') 1 151 124 82 Totals 40 9,335 8,177 88 63 ROUTINE MEDICAL INSPECTION. A.— Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 693 Second Age Group 965 Third Age Group 743 Total 2,401 Of 2,401 children who were examined in the code age-groups, 1,986 (or over 82 per cent.) were accompanied by their parents. B.— Other Inspections. Special Inspections. The number of special inspections during the year was 3,387 comparing with 2,797 during the previous year. Re-inspections. The number of re-inspections during 1945 was 6,426. 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. (1) Number of Children. Percentage of Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) Code Groups— Entrants 693 227 32.7 Second Age Group 965 214 22.1 Third Age Group 743 246 33.1 Total (Code Groups) 2,401 687 28.7 Uncleanliness and Verminous Conditions.— At the special inspections held by the school nurses, 1,247 children were found to be unclean out of a total number of 20,224 examined (i.e., 6.1 per cent.) 64 Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 1,198 34 7 Capworth Street 1,540 139 35 Cann Hall Road 1,155 37 16 Church Road 1,369 117 20 Connaught Road 1,161 35 15 Downsell Road 1,491 87 29 Davies Lane 1,680 53 7 Farmer Road 1,227 27 10 Goodall Road 750 45 14 Kirkdale Road 309 2 1 Lea Bridge Road 141 5 0 Mayville Road 1,759 231 44 Norlington Road 1,699 48 16 Newport Road 1,943 55 21 Sybourn Street 1,058 25 2 St. Joseph's 338 5 2 Trumpington Road 1,100 40 10 Knotts Green 115 7 3 Leyton County High School 191 3 — Total 20,224 995 252 Number of individual children found unclean 1,247 of whom 252 were referred to the Minor Ailments Clinics. 65 Return of Defects found by Medical Inspection in the Year ended 31st December, 1945. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin f Ringworm— Scalp ... ... 13 ... Body 1 ... 7 ... Scabies 3 ... 70 ... Impetigo 4 ... 90 ... Other diseases (non-T.B.) 27 1 1,118 1 Eye Blepharitis 9 ... 44 ... Conjunctivitis 1 ... 82 ... Keratitis 3 ... ... Corneal Opacities ... ... 2 ... Defective Vision 134 16 227 ... Squint 33 2 82 ... Other conditions 9 ... 24 1 Ear Defective Hearing 4 1 19 ... Otitis Media 11 6 44 ... Other Ear Diseases 11 3 222 ... Nose & Throat Chronic Tonsilitis only 19 17 106 ... Adenoids only 6 3 4 ... Chronic Tonsilitis & Adenoids 19 8 19 ... Other conditions 44 ... 323 ... Enlarged Cervical Glands (non-T.B.) 5 2 56 ... Defective Speech 8 2 24 ... Heart and Circulation Heart Disease— Organic 2 ... 5 ... Functional 1 18 9 ... Anaemia 6 ... 44 ... Lungs Bronchitis 35 3 81 ... Other non-T.B. Diseases 9 16 56 ... Tuberculosis Pulmonary— Definite ... ... 3 ... Suspected ... 2 4 ... Non-Pulmonary— Glands 2 3 1 ... Bones and Joints ... ... ... ... Skin ... ... ... ... Other Forms ... ... ... ... Nervous Epilepsy 2 1 3 ... Chorea 1 ... 5 ... System Other conditions 10 6 58 ... Rickets 1 ... ... ... Deformities Spinal Curvature 1 ... 2 ... Other Forms 176 6 60 ... Other Defects and Diseases 90 10 1,990 1 Totals 687 126 4,897 3 66 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 2,743 children attended the clinics, and 13,312 attendances were registered. Defective Vision.— Of the 2,401 children subjected to routine code group inspection in the schools, 156 (6.4 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 690 children, who made 953 attendances for examination and treatment. Squint Clinic. Number of attendances 1,141 New cases 59 Number of cases treated with orthoptic exercises and for amblyopia 102 Cured of Amblyopia 9 Discharged— Cured 7 Improved 11 Unresponsive 2 Unsuitable 3 Operations for squint 4 Awaiting operation 10 Under observation, attending for "tests only" 1 6 67 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. GLtIb. Canterbury 316 166 185 103 260 90.2 Cann Hall 229 176 94 79 144 83.23 Capworth 212 351 134 255 257 66.06 Church ... ... ... ... ... ... Connaught ... ... ... ... ... ... Da vies Lane 375 186 179 69 150 59.1 Downsell 284 243 230 198 346 80.8 Farmer 396 180 256 107 252 69.4 Goodall 216 233 169 174 228 66.5 Kirkdale 40 22 14 7 18 85.7 Knotts Green 42 35 28 30 38 65.5 Lea Bridge 25 31 19 22 31 75.6 May ville 180 296 91 154 131 53.5 Newport 548 204 286 95 237 62.2 Norlington 225 498 82 266 255 73.2 Sybourn 427 214 319 148 336 71.9 St. Joseph's 42 116 63 53 80 68.9 Tom Hood ... ... ... ... ... ... Trumpington 141 141 79 76 90 50.8 3,698 3,092 2,228 1,836 2,853 70.1 Report by the Authority's Senior Dental Officer (A. E. Hall, L.D.S.) General. Conditions during the early part of the year under review were still abnormal due to enemy action, and the continued evacuation of the school children ; but with the end of the war and the return of many of the children conditions and attendances rapidly improved. The acceptance of treatment rate over the whole year was 70.1 per cent., an increase over the previous year of 9 per cent. It was noticed that a big proportion of the regular attendants also accepted the offer of evacuation. The dental staff consists of two dental surgeons and two dental attendants, being one dental surgeon and one dental attendant short by comparison with the immediate pre-war period. 68 There is still a marked improvement in the number of sound mouths of school entrants at 5 years of age, which would appear to be due to a decrease in the amount of sweets eaten by these children, together with dietary improvements such as an increased milk consumption, the use of cod liver oil, fruit juices and the addition of calcium salts to the bread. An examination was carried out with a view to comparing the school entrants with those of the year 1939, when it was found that the percentage of sound mouths in the 1945 school entrants was 57.45 per cent., compared to 39.01 per cent, in 1939. Elementary Schools. All schools in the Borough, with the exception of Connaught and Church Road (which were inspected at the end of 1944) were dentally inspected during the year; but due to a gradual return of the school population from evacuation it could not be said at the end of the year that all school children in the area had been dentally inspected during the year. The percentage of acceptance rate was 70.1 per cent. The number of attendances for treatment during the year showed an increase over the previous year, with a slight decrease in the amount of conservative work done and an increase in the number of extractions, due in part to children returning from evacuation who had not received regular treatment when away. Particularly was this noticed in children returning from rural areas. Table IV in the Statistical Summary gives some idea of the work done for the Elementary School Children. Secondary Schools. The pupils of both the County High Schools for Boys and for Girls were inspected and treated during the year. The big discrepancy in the Secondary School (Table IV) between the number found to require treatment and the number actually treated is due to the period of treatment running over the year end and into 1946. The acceptance of treatment rate in the Boys' School was 65.73%. „ ,, Girls' „ „ 66.24%. 69 Orthodontics. In addition to a large number of orthodontic cases treated wholly or partially by extraction, a number of appliances have been made during the year, all of the removable type. The cases selected have usually been those likely to yield quick results. The long treatments needing complicated apparatus have not been undertaken, in view of the depleted staff and the prior demands of routine conservative dentistry. They have usually been referred to hospital. An X-ray apparatus is almost indispensable before undertaking many of these cases. Maternity and Child Welfare. All cases referred by the Medical Officers have been seen and advised or treated. The number of mothers attended was about the same as the previous year— with a slight increase in the amount of conservative work done, but the number of infants seen was double that of the previous year, as was also the amount of work done. Some idea of the amount of work done will be found under the heading Dental Treatment in the M. & C. W. report, including the number of dentures supplied. War-time Day Nurseries. The children over two years of age attending the Day Nurseries were inspected and treated, if necessary, during the year. The number of sound mouths was found to be 81.6 per cent., and the acceptances of treatment 81.8 per cent, of those referred for treatment. Orthopaedic Clinic. The following figures show the number of school children examined and treated during the year. Examinations. Primary examinations 50 Re-examinations 106 Treatment. Number of children who attended for 181 Attendances made 1,428 70 The findings at the primary examination were as follows:— Deformities— Bones and Joints. (a) Congenital— Sprengel— left 1 Deformity digits— foot 4 (b) Acquired— Hammer toe 4 Hallux valgus 5 Bowed tibiæ 1 Genu varum 1 Genu valgum 6 Injury— knee 1 Old fracture— femur 1 T.B. ankle 1 Muscular. (a) Congenital— Torticollis 2 Talipes 2 (b) Acquired— Scoliosis 3 Kyphosis 1 Winged scapulae 1 Pes cavus 2 Pes piano valgus 16 Valgus ankles 2 Metatarsalgia 1 Paralysis. (a) Congenital— Spastic hemiplegia 2 Spastic diplegia 1 (b) Acquired— Anterior Poliomyelitis 3 Also— Kohler's disease 1 Fibrocystic disease— arm 1 71 Admissions to Hospital. Three children were admitted to hospital and the following operations performed— 1. Subcutaneous tenotomy— both heads— sterno mastoid and plaster cast jacket. 2. Triple arthrodesis foot— left— plaster of Paris. 3. Rotatory osteotomy— humerus— right. Surgical Appliances and Boots. The following have been supplied— Genu valgum braces, wedges and tunnels to boots 2 Surgical boot 1 Surgical alterations to boots 2 Minor alterations to boots and shoes 40 Repairs to surgical boot 1 Artificial Sunlight Clinic. Number of children attending 154 Attendances made 3,186 HANDICAPPED PUPILS. Statutory Medical Examinations. During the year, some 79 children were referred for statutory medical examination. As the result of examination these 79 children were classified as follows:— Behaviour Problems:— With average intelligence 15 Above „ ,, 5 Dull and backward 17 „ ,, ,, requiring re-assessment 16 Educationally sub-normal requiring special education... 18 Children notified as requiring supervision 2 ,, decertified 3 ,, reported to the Local Authority under Section 57 of the Education Act 3 79 72 Knotts Green Special School for Educationally Sub-Normal Pupils. Admitted 15 Discharged 12 Physically Handicapped Pupils. Knotts Green Open Air School. Admitted during the year 19 Discharged 15 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1945 was:— Ordinary Meals. Milk Meals. Free 1,361 2,545 For payment 6,530 10,297* Totals 7,891 12,842 *Estimated. Number of meals supplied:— Ordinary Meals. Milk Meals. Free 131,687 472,486 For payment 561,107 1,940,831 Totals 692,794 2,413,317 The above figures relate to the financial year ended 31st March, 1946. CHILD GUIDANCE. As long ago as 1937 arrangements were made for the reference to special Child Guidance Clinics of children showing anti-social behaviour problems; and during the year under review six school children were referred to such special clinics for investigation and report. In the early years of school medical inspection it was realised that many school children presented behaviour problems. Some of these anti-social tendencies could be attributed to hereditary 73 disposition, and some to physical defect; but there remained many which could not be attributed to either of these causes. With the increase during recent years in knowledge of child psychology it has been found possible to find a remedy for many behaviour problems which were formerly considered to be untractable. Child guidance work is a fairly recent development; and, whereas its application is making steady progress, its methods have by no means reached a final stage. All children are subject to moral and social training in varying degrees. Child guidance is not a substitute for such training, but it does help the training to be more effective in cases where it has failed. Most children can adapt themselves to any environment, some (mental and moral defectives) find it impossible to adapt themselves to any environment, and many can adapt themselves only to the environment particularly suited to their constitution. It is the function of child guidance to deal with the last category. The chief difficulty in the application of child guidance is inability to exercise adequate control over unsuitable parents. Whereas other environmental factors are controllable, the most important factor (parentage) often presents difficulty and obstruction which is difficult to overcome. SPEECH THERAPY. For some years past the work of the Speech Therapist has been regarded as primarily educational, and the majority of those employed by Local Education Authorities have in fact been recognised or approved as specialist teachers under Schedule I (6) or II (5) of the Code of Regulations for Public Elementary Schools. When they were engaged full-time in or in connection with the schools their service has been counted as contributory service under the Teachers (Superannuation) Acts. Recently, however, there have been certain changes in the courses of training for Speech Therapists and in the actual work on which they are employed. In England the training is now given in four Training Schools, each of which is maintained by, or conducted in close association with, a hospital and comprises instruction in anatomy, physiology, neurology, pathology of the ear, nose and throat, phonetics and speech therapy. It does not include training in teaching, in handling classes of children or in school practice. Correspondingly the work which the Speech Therapists have to do has been decreasingly educational and more curative. It is carried out, in part at least, under medical supervision; and the only persons 74 whose employment as Speech Therapists is approved by the Minister are those who have been admitted to the Register of Medical Auxiliaries. Under the circumstances the Minister of Education (Administrative Memorandum No. 101) issued an instruction that, from 1st November, 1945, Speech Therapists employed by Local Education Authorities shall be treated as members of the staff of the School Medical Service and shall not thereafter be regarded as teachers. Prior to the transfer on 1st November the two Speech Therapists employed by the Education Authority had been working in close collaboration with the school medical staff. It is proposed that a summary of their work will be included in future annual reports of the School Medical Officer. SCHOOL CAMP, ITCHINGFIELD. The School Camp at Coopers Farm, Itchingfield, near Horsham, Sussex, which was controlled by the Leyton Education Committee for the purpose of evacuation from April, 1940, ceased to function for that purpose in July, 1945. Following the issue of Ministry of Education Circular 17 inviting Education Authorities to apply for the use of National Camps for educational purposes, the Essex Education Authority decided to take over the tenancy of this Camp for an initial period of 12 months, and three parties of approximately 240 children each, spent periods of five weeks, five weeks and four weeks respectively at the Camp during the period 14th September to 21st December, 1945, on which date the establishment closed for the winter. The Camp is available for all Senior children from the Forest, Leyton and Walthamstow Divisions, with the places divided equally among the three areas. It is the intention of the Authority to continue to send parties of 240 children for 10 periods of 4 weeks each throughout the calendar year. In addition to these places available for normal children, arrangements have been approved by the Education Authority for the reservation of a limited number of places (from 10 to 15) for straightforward cases of convalescence (boys and girls) from the 3 areas concerned. Four girls were sent to Camp for convalescence under these arrangements during the period July—December, 1945, and the experiment proved so successful that it is proposed to continue to take full advantage of the facilities available at the Camp for these selected cases. Convalescent cases will normally spend three months at the Camp. 75 PUBLIC ELEMENTARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections, a. Routine Medical Inspections. Number of Code Group Inspections:— Entrants 693 Second Age Group 965 Third Age Group 743 Total 2,401 b. Other Inspections. Number of Special Inspections 3,387 Number of Re-inspections 6,426 Total 9,813 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 2 225 227 32.7 Second Age Group 63 151 214 22.1 Third Age Group 69 177 246 33.1 Total (Prescribed Groups) 134 553 687 28.7 Other Routine Inspections — — — — Grand Total 134 553 687 28.7 76 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 693 141 20.3 381 54.9 169 24.4 2 0.3 Second Age Group 965 238 24.5 603 62.5 123 12.7 1 0.1 Third Age Group 743 204 27.5 420 56.6 117 15.7 2 0.2 Other Routine Inspections - - - - - - - - - Total 2,401 583 24.3 1,404 58.4 409 17.0 5 0.2 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1945. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table V). Disease or Defect. (1) Number of Defects treated or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm— Scalp— (1) X-ray treatment 3 — 3 (2) Other 10 — 10 Body 7 — 7 Scabies 70 — 70 Impetigo 90 — 90 Other skin diseases 863 — 863 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 296 296 Minor Ear Defects 266 — 266 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 795 — 795 Total 2,400 — 2,400 77 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments.—Group I). Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Errors of refraction (including squint) 538 — 538 Other defect or disease of the eyes (excluding those recorded in Group I) 106 3 10) Total 644 3 647 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom Spectacles were:— (a) Prescribed 444 — 444 (6) Obtained 444 - 444 TABLE III .—contd. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Other Forms of Treatment. (4) Total Number Treated. (5) Received Operative Treatment. Under the Authority's Scheme in Clinic or Hoipital. (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) (1) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) — 1 25 — 8 — 5 8 8 1 30 8 83 130 (1) Tonsils only. (2) Adenoids only. (3) Tonsils and adenoids. (4)Other defects of the nose and throat. 78 TABLE IV. Dental Inspection and Treatment. (1) Number of children who were:— (a) Inspected by the Dentist:— Age Groups Aged 3 8 4 264 5 685 6 769 7 736 8 705 9 10 720 770 Total 6,790 11 632 12 639 13 614 14 233 15 14 16 1 Specials (Casuals) 796 Grand Total... 7,586 (6) Found to require treatment 4,860 (c) Actually treated 3,253 (2) Half-days devoted to Inspection 69£ Treatment 762J—Total 825 (3) Attendances made by children for treatment 5,111 (4) Fillings, Permanent Teeth 2,957 Temporary „ 625—Total 3,582 (5) Extractions, Permanent Teeth 576 Temporary „ 4,667—Total 5,243 (6) Administrations of general anaesthetics for tions 1,517 (7) Other operations, Permanent Teeth 351 Temporary ,, 193—Total 544 79 TABLE V. Uncleanliness and Verminous Conditions. (1) Average number of cleanliness inspections per school made during the year by the School Nurses 3 (2) Total number of examinations of children in the Schools by School Nurses 20,224 (3) Number of individual children found unclean 1,247 (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 — — — — 80 SECONDARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections. A. Routine Medical Inspections. Number of Code Group Inspections:— County High School for Boys 136 ,, Girls 194 Total 330 Number of other Routine Inspections — b. Other Inspections. Number of Special Inspections 188 Number of Re-inspections 348 Total 536 Children Found to Require Treatment. Group. (1) Number of Children. Percentage of Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) County High School for Boys 136 33 24.2 County High School for Girls 194 52 26.7 TABLE II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups. No. of Children Inspected. A. (Excellent.) B. (Normal.) C. (Slightly Subnormal.) D. (Bad.) No. % No. % No. % No. % County High School for Boys 136 40 29.4 88 64.7 8 5.15 ... ... County High School for Girls 194 77 39.6 i 99 51.0 18 9.2 ... ... 81 TABLE III.—Return of Defects Treated during the Year. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanlineas). Disease or Defect. (1) Number of Defects treated or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm— Scalp— (1) X-ray treatment - — — (2) Other — — — Body — — — Scabies I — 1 Impetigo 1 — 1 Other skin diseases 32 — 32 Minor Eye Defects— (External and other, but excluding eases falling in Group II) 21 - 21 Minor Ear Defects 11 — 11 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 27 — 27 Total 93 — 93 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments.—Group I). Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Errors of refraction (including squint) 69 - 69 Other defect or disease of the eyes (excluding those recorded in Group I) 18 87 — 18 Total — 87 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 58 (b) Otherwise 82 TABLE IV. Dental Inspection and Treatment. (1) Number of children who were:— (a) Inspected by the Dentist:— Age Groups Aged: Total 832 9 1 10 4 11 138 12 151 13 108 14 181 15 110 16 45 17 32 18 2 Specials (Casuals) Nil Grand Total 832 (6) Found to require treatment 478 (c) Actually treated 179 (2) Half-days devoted to Inspection 6 Treatment 46—Total 52 (3) Attendances made by children for treatment. 257 (4) Fillings, Permanent Teeth 315 Temporary ,, 1—Total 316 (5) Extractions, Permanent Teeth 47 Temporary „ 27—Total 74 (6) Administrations of general anassthetice for extractions 22 (7) Other operations, Permanent Teeth 61 Temporary ,, Nil—Total 61