Ley 40 Borough of Lepton. HEALTH REPORT FOR THE YEAR 1946. ANDREW W. FORREST, m.a., m.d., ch.b., d.p.h., Medical Officer of Health, School Medical Officer. ' 1 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEY TON. Mr. Mayor, Ladies and Gentlemen, I 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 1946. The last official census of the population was taken in 1931, when the population of the Borough of Leyton was shown to be 128,313 persons. As the census is taken at intervals of ten years, there should have been one taken in 1941, but unfortunately it was impossible owing to the war. During the inter-censal periods the official population figure is an estimate made by the Registrar General, who takes into consideration such factors as births, deaths, migration, etc. Since the outbreak of war the National Registration and the Food Office figures have provided a valuable check. During the last pre-war year (1938) the Registrar General's estimate of the population of Leyton was 117,200; and his estimated figure for the first complete post-war year (1946) is 101,910. The number of births registered in the Borough during 1946 was 2,223—the highest annual number registered since the year 1923, when the population was 132,800. In 1946 the birth-rate was 21.81 live births per thousand of the population; in 1923 the corresponding rate was 17.53. The last year in which the birth rate exceeded 21.81 was in 1920. The infant mortality rate (i.e. the number of deaths of infants under one year of age per thousand registered live births) in Leyton for the year under review was 28.78—a new low record. The previous lowest rate (31.65) was in 1939. In consequence of the greater attention now being devoted by local authorities to the care and welfare of illegitimate mothers and their children, it is significant that the death rate of illegitimate infants (23.25) is less than that of the legitimate (29.01). In Table V (page 11) is shown the comparative birth rate, death rate and infant mortality rate figures for England and Wales, Great Towns, Smaller Towns and Leyton. On page 12 there is a table showing how the population and vital statistics of Leyton have varied during the last 55 years. No outstanding epidemic of infectious disease occurred during the year. The incidence of measles diminished from 797 notified 2 cases in 1945 to 439 cases in 1946. The prevalent type of scarlet fever continues to be mild, and no death due to scarlet fever has been recorded during the last five years. Owing to the continued rise in the birth rate (2,223 births in 1946, compared with 1,474 during the previous year), your Council's arrangements for institutional and domiciliary midwifery have been subjected to great strain— due in great part to the difficulty in recruiting midwifery and domestic staff. A welcome and much needed reform is the official approval recently given for the use of motor cars for the transport of midwives. On 12th August the Council, with the co-operation of the Women's Voluntary Service, put into operation a new scheme for the supply of Home Helps and Domestic Helps. Details of the scheme will be found in pages 40-42. In accordance with the provisions contained in the Education Act, 1944, the County Council is now the Local Education Authority. Leyton—formerly a Part III Education Authority—is now an "Excepted District," with a Leyton Committee for Education, in which members of the County Council have been co-opted. Although the County Council is directly responsible for such matters as policy, finance and staffing, the actual school Medical Service arrangements have been delegated to the local Divisional Executive and continue to be carried out by the medical, dental, nursing and specialist staff of the former Part III Education Authority. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Cwal ferrsh 4 Extract from Vital Statistics for the year 1946. Live Births:— Legitimate Males 1138 Females 999 Illegitimate Males 44 Females 42 Totals 2,223 Birth Rate per 1,000 of population 21.81 Stillbirths :— Males 23 Females 30 Rate per 1,000 total (live and still) births 23.28 Deaths:— Males 585 Females 596 Totals 1,181 Death Rate per 1,000 11.58 Number of women dying from diseases and accidents of pregnancy and childbirth :— From Sepsis 2 From other causes 1 Rate per 1,000 total (live and still) births 1.31 Death rate of infants under one year of age :— All infants per 1,000 live births 28.78 Legitimate infants per 1,000 legitimate live births 29.01 Illegitimate infants per 1,000 illegitimate live births 23.25 Deaths from Cancer (all ages) 185 „ „ Measles (all ages) 2 „ „ Whooping Cough (all ages) 2 „ „ Diarrhoea (under 2 years of age) 7 TABLE 1. Registered Births, 1946. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 8 10 6 6 9 6 7 8 7 5 72 February 9 9 6 9 13 9 5 10 4 7 81 March 6 10 9 4 3 8 7 7 10 4 68 April 3 6 4 9 8 9 8 5 3 3 58 May 10 13 5 11 13 14 9 6 9 4 94 June 5 12 4 14 10 8 5 7 12 6 83 July 3 15 8 8 13 5 2 3 7 4 68 August 11 7 7 7 8 6 8 9 11 4 78 September 7 11 4 12 10 7 3 8 4 6 72 October 9 13 9 9 17 8 3 11 5 1 85 November 4 15 10 10 21 11 12 6 8 12 109 December 9 10 13 10 8 9 12 10 7 7 95 Transferables 98 206 112 126 257 185 76 77 80 43 1,260 Totals 182 337 197 235 390 285 157 167 167 106 2,223 5 TABLE 2. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1946. 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. 16 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 3 1 ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough M 2 1 1 ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria M 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system M 27 ... ... ... ... 4 5 3 "s 6 1 ... ... ... F 17 ... ... ... 1 2 6 3 3 1 ... 1 ... ... 7. Other forms of tuberculosis M 2 1 1 ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 8. Syphilitic disease M 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Influenza M 5 ... ... ... ... ... ... ... 2 1 2 ... ... ... F 8 ... ... 1 ... 1 ... ... 1 1 ... 4 ... ... 10. Measles M 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) M 7 ... ... ... ... ... ... ... ... ... 5 2 ... ... 13. Cancer of uterus F 10 ... ... ... ... 1 ... 1 1 1 4 2 ... ... 14. Cancer of stomach and duodenum M 12 ... ... ... ... ... ... ... ... 5 5 2 ... ... F 24 ... ... ... ... ... 1 1 1 7 6 8 ... ... 6 15. Cancer of breast M 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... F 16 ... ... ... ... ... 1 1 5 5 3 1 ... ... 16. Cancer of all other sites M 71 ... ... 1 ... ... 1 2 11 14 27 15 ... ... F 44 ... ... 1 ... ... ... 2 5 10 16 10 ... ... 17. Diabetes M 3 ... ... ... ... ... ... ... ... 1 2 ... ... ... F 4 ... ... ... ... ... 1 ... ... 2 1 ... ... ... 18. Intra-cranial vascular lesions M 49 ... ... ... ... ... ... 3 1 7 17 21 ... ... F 71 ... ... ... ... ... ... 2 ... 9 24 36 ... ... 19. Heart disease M 112 ... ... ... ... 1 1 4 4 28 41 33 ... ... F 160 ... ... ... ... ... 2 6 10 13 45 82 ... ... 20. Other diseases of circulatory system M 17 ... ... ... ... ... ... ... ... 9 5 3 ... ... F 25 ... ... ... ... ... ... ... 1 5 9 10 ... ... 21. Bronchitis M 77 ... ... ... ... ... 1 1 5 18 25 27 ... ... F 45 ... ... ... ... ... 1 2 ... 6 14 22 ... ... 22. Pneumonia M 26 3 ... ... ... ... ... 2 1 5 8 7 ... ... F 22 8 ... ... ... ... 1 4 ... 1 ... 8 ... ... 23. Other respiratory diseases M 6 1 ... ... ... ... 1 2 ... 1 1 ... ... ... F 5 ... ... ... ... ... 1 1 ... 1 I 1 ... ... 24. Ulceration of the stomach or duodenum M 16 ... ... ... ... ... 2 1 4 4 4 1 ... ... F 4 ... ... ... ... 1 ... ... ... ... 1 2 ... ... 25. Diarrhoea (under 2 years of age) M 5 4 1 ... ... ... ... ... ... ... ... ... ... ... F 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 26. Appendicitis M 2 ... ... ... ... ... ... 1 ... ... ... 1 ... ... F 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... 27. Other digestive diseases M 12 ... ... ... ... ... ... ... 2 3 3 4 ... ... F 8 ... ... ... ... 1 ... ... ... 1 3 3 ... ... 28. Nephritis M 10 ... ... ... ... 1 ... ... 1 3 2 2 ... ... F 10 ... ... ... ... ... 2 1 ... 5 ... 2 ... ... 29. Puerperal and post-abortive sepsis. F 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... 30. Other maternal causes F 1 ... ... ... ... ... ... ...l... ... ... ... ... ... ... 31. Premature birth M 12 12 ... ... ... ... ... ... ... ... ... ... ... F 6 6 ... ... ... ... ... ... ... ... ... ... ... ... 32. Congenital malformations M 13 13 ... ... ... ... ... ... ... ... ... ... ... ... F 11 11 ... ... ... ... ... ... ... ... ... ... ... ... 33. Suicide M 6 ... ... ... ... ... ... ... 2 1 2 1 ... ... F 8 ... ... ... ... ... ... ... 6 2 ... ... ... ... 34. Road traffic accidents M 5 ... ... ... ... ... ... 2 1 ... 1 1 ... ... F 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 35. Other violent causes M 12 ... ... ... 1 ... 1 1 ... 5 ... 4 ... ... F 5 ... ... ... ... ... ... ... ... ... 1 4 ... ... 36. All other causes M 68 ... ... 2 2 2 ... 3 2 11 10 36 ... ... F 84 1 ... 1 2 1 ... 2 3 5 11 58 ... ... Totals M 585 64 5 8 10 15 31 52 80 199 303 414 1618 444 F 596 7 TABLE 3. DEATHS IN WARDS, 1946 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 6 6 7 8 9 10 11 12 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal fever ... ... ... ... ... 1 ... ... 1 1 ... 3. Scarlet fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough ... 1 ... ... ... ... ... 1 ... ... ... 5. Diphtheria ... ... ... ... ... ... 1 ... ... ... ... 6. Tuberculosis of respiratory system 2 6 1 5 4 10 3 3 6 4 ... 7. Other forms of tuberculosis ... ... ... ... 1 ... 1 ... 1 ... ... 8. Syphilitic diseases ... ... ... ... 1 ... ... ... ... ... ... 9. Influenza ... 2 1 1 1 2 ... 3 2 1 ... 10. Measles ... ... ... ... 1 ... ... 1 ... ... ... 11. Acute poliomyelitis and polioencephalitis ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis ... ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) 2 ... 1 ... 2 2 ... ... ... ... ... 13. Cancer of uterus ... 2 1 1 1 2 ... 1 ... 2 ... 14. Cancer of stomach and duodenum 4 4 4 ... 7 5 3 4 1 1 ... 15. Cancer of breast 2 2 ... 2 3 2 2 2 1 1 ... 16. Cancer of all other sites 13 20 6 5 23 11 15 5 13 4 ... 17. Diabetes ... ... 1 1 1 ... ... 1 2 1 ... 18. Intra-cranial vascular lesions 4 22 7 10 18 13 8 11 16 II ... 19. Heart disease 13 42 18 28 58 32 25 18 26 12 ... 20. Other diseases of circulatory system 4 5 5 3 7 9 3 3 1 1 1 21. Bronchitis 10 21 4 7 15 13 14 12 15 10 1 22. Pneumonia 3 14 3 4 4 4 3 6 5 2 ... 23. Other respiratory diseases ... ... 2 1 1 6 ... ... 1 ... ... 24. Ulcer of stomach or duodenum 1 9 2 2 2 ... 1 1 1 1 ... 8 25. Diarrhoea (under 2 years) ... ... 1 2 1 ... 1 1 1 ... ... 26. Appendicitis ... 1 ... ... ... 2 1 ... ... ... ... 27. Other digestive diseases 2 2 3 2 3 2 1 3 2 ... ... 28. Nephritis ... 5 1 2 4 2 1 3 ... 2 ... 29. Puerperal and post-abortive sepsis ... ... ... ... 1 1 ... ... ... ... ... 30. Other maternal causes ... ... ... ... ... ... 1 ... ... ... ... 31. Premature birth ... 2 4 2 3 2 2 ... 3 ... ... 32. Congenital malformations 2 ... 5 1 6 2 ... 6 1 1 ... 33. Suicide 2 3 ... 2 1 1 2 1 1 1 ... 34. Road Traffic accidents ... 1 ... ... 1 1 ... 2 1 ... ... 35. Other violent causes 3 7 ... ... 2 2 1 2 ... ... ... 36. All other causes 13 25 13 17 22 18 11 11 10 12 ... Totals 80 196 83 98 194 145 100 101 114 68 2 9 TABLE 4. Vital Statistics of Whole District during 1946 and Previous Years. Year. Births. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Inward Transferables Nett. of Nonresidents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 3 4 5 6 7 8 9 10 11 12 13 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 1508 12.87 2934 25.0 1938 152 70 46.38 1148 9.79 1939 605 1499 12.90 2951 26.6 1987 278 46 31.65 1242 11.21 1940 645 1353 14.02 3865 40.0 2302 335 50 39.03 1563 16.2 1941 705 1129 13.31 2430 28.6 1288 341 37 38.30 1142 13.46 1942 814 1452 16.69 2373 27.3 1546 296 73 50.27 1123 12.91 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 1946 1260 2223 21.81 2611 25.6 1646 210 64 28.78 1181 11.58 10 TABLE 6. Birth-rate, Death-rate and Analysis of Mortality During the Year 1946 Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Rnterio 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 19.1 0.53 11.5 0.00 0.00 0.00 0.00 0.02 0.01 0.15 4.4 43 126 County Boroughs and Great Towns, including London 22.2 0.67 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.13 6.1 46 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 21.3 0.59 11.7 0.00 0.00 0.00 0.00 0.02 0.01 0.14 2.8 37 London 21.5 0.54 12.7 0.00 — 0.01 0.00 0.02 0.01 0.12 4.2 41 LEYTON 21.81 0.52 11.53 0.00 0.00 0.02 0.00 0.02 0.01 0.12 3.1 28 83.7 3.3 13.0 ... 11 12 TABLE 6. Comparative Statistics or Bibths, Mortality, Etc. LEYTON, 1892-1946. 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 1896 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* D121420* 2560 19.4 1471 12.1 197 76.9 1917 B125352* Dl12452* 2005 16.0 1414 12.6 172. 85.8 1918 Bl25352* Dl12452* 1791 14.3 1723 15.3 161 89.9 1919 Bl29062* D123896 2195 17.0 1397 11.3 154 70.16 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 B116100* 1509 12.87 1148 9.79 70 46.38 1939 Dl10800* 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 1946 101910 2223 21.81 1181 11.58 64 28.78 * Population as estimated for purposes of B, Birth Rate, D, Death Rate. 13 GENERAL PROVISIONS OF HEALTH SERVICES FOR THE AREA. FOOT CLINIC. Summary of Attendances and Treatment. During the year 9,042 attendances for treatment were made, representing an increase of 3,007 over the attendances during the previous year. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 170 1,456 1,626 Females 520 6,084 6,604 Children 132 680 812 Total 822 8,220 9,042 During the year the number of persons who received free treatment was 71 (8.63 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 15 56 383 1,486 398 1,542 Unemployed — — 14 27 14 27 Widows — — — — — - Totals 15 56 397 1,513 412 1.569 Defects Treated. Bursitis 33 Callosities 205 Corns, hard 159 Corns, soft 39 Corns, under nail 12 Hallux rigidus 6 Hallux valgus 39 Metatarsalgia 40 Nails, club 19 Nails, ingrowing 40 Pes cavus 4 Pes planus 34 Pes valgus 3 14 Verruca pedis 115 Hammer toe 2 Septic conditions 20 Conditions due to sprain 5 Bromidrosis 4 Referred for Medical or Surgical Treatment. During the year 4 patients were referred to their own private medical practitioners for the following conditions :— OEdema 2 Fibrositis 1 Nail in foot 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 months) - - 303 1291 1943 522 632 1154 2490 1944 328 517 845 1990 1945 302 454 756 1462 1946 261 402 663 1298 Attendances during 1946. Number of patients treated 663 Children 261 Adults 402 Number of patients who had One routine treatment 663 Two ,, ,, 372 Three „ „ 109 Four „ „ 25 Five „ „ 8 Six „ „ 1 Local treatment, no bath 120 1,298 15 Source of New Cases :— Referred by Hospitals 34 Referred by General Medical Practitioners 241 Referred by Council's Medical Staff 132 Contacts 256 663 CIVIL AMBULANCE SERVICE. The following table gives particulars of the cases transported in Council ambulances during the year :— Accidents 326 Taken ill in street 178 Maternity 599 Attempted suicide 6 Transfers to and from hospitals 967 2,076 The mileage covered during the year was 13,154. It will be seen that the most frequent calls made in the Council's ambulances are (a) for the transfer of patients to and from hospitals, and (b) for the transport of expectant mothers to hospitals for confinement. A large proportion of both these categories are not stretcher cases, and it is obviously uneconomic and unnecessary to provide ambulances for their transport. Your Council therefore decided to acquire a new sitting-case car (a 12 h.p. four-seater) for such sitting cases; and, although the car was ordered in May, it had not been delivered by the end of this year. PUBLIC TRANSPORT FACILITIES. In my last Annual Report I had occasion to deal with the appalling conditions under which Leyton residents had to travel to and from L ondon, and to draw attention to the fact that overcrowded public transport vehicles were a most fruitful source of respiratory infection. The extension of the Central London Underground Railway to Leyton and Leytonstone should result in a welcome relief to travellers by train; and it is hoped that the improved railway service will have an appreciable effect in diminishing the length of the queues of travellers by bus and train. 16 Number of Inquests held 11 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 28 ,, occlusion—atheroma 8 Rupture of aorta 3 Rheumatic carditis 1 Myocardial degeneration 2 Myocarditis 1 Mitral stenosis 1 Suppurative broncho pneumonia 1 Bronchitis 2 Pulmonary embolism 1 Ruptured pleural adhesions 1 Cerebral spinal fever 1 Myeloid leukaemia 1 Carcinoma of prostate 1 ,, ,, stomach 1 Stillborn 1 Inhalation of birth fluids 1 Cerebral haemorrhage 2 Hypertension 7 Inquests. The following verdicts on Leyton residents were recorded at inquests held during the year :— Accidental 23 Suicide 13 Natural causes 2 Open verdict 1 PUBLIC MORTUARY. Number of bodies deposited, death being due to :— Natural causes 64 Suicide 8 Other accidents 2 Drowning 1 75 Number of Post-mortem examinations performed 62 17 HEALTH CENTRES Since their inception, the School Medical Service and the Maternity and Child Welfare Service have developed along the lines of healthy living organisms by showing marked growth and expansion, often in directions which could not have been foreseen accurately. Requirements have been met as they have arisen, systems have been devised piecemeal, and arrangements have often been necessarily of a makeshift nature. Unfortunately the accommodation and equipment adequate for the operation of two such rapidly increasing services have not increased pari passu with the developments in the service. In 1933 there was opened at Leyton Green a Joint Health Centre to accommodate the clinic health services for the western half of the Borough; and in 1935 a similar Joint Health Centre was opened at Park House, Granleigh Road, to serve the eastern half of the area. When they were built, these two health centres were considered to provide the most modern facilities for the joint health services; but even in the intervening period of twelve years which has elapsed since their erection, the scope and nature of municipal health services has undergone such expansion that these two buildings are no longer adequate for present day needs. During the war years both these health centres sustained substantial war damage on several occasions; but, in spite of this, they continued to fulfil their purpose. Early in 1946 the Committee concerned began to consider the acquisition of a suitable site for the erection of a new Combined Main Health Centre to accommodate all municipal medical and ancillary health services, along with the possibility of the provision of accommodation for the health centre activities envisaged in the new National Health Service Act (then a Bill). In June the Medical Officer of Health submitted the following summary of the proposals. National Health Service Act—Summary of Proposals Scope of the Service. The Act provides for the following kinds of health services : 1. Hospital and specialist services. These cover in-patient and out-patient services, the latter including clinics and dispensaries operated as part of any specialist service. The advice and services of specialists of all kinds are also to be made available where necessary, at Health Centres and in the patient's home. 18 2. Health Centres and general practitioner services— i.e., general personal health care by doctors and dentists whom the patient chooses. These personal practitioner services are to be available both from new publicly equipped Health Centres and also from the practitioners' own surgeries. 3. Various supplementary services—including midwifery, maternity and child welfare, health visiting, home nursing, a priority dental service for children and expectant and nursing mothers, domestic help where needed on health grounds, vaccination and immunisation against infectious diseases, additional special care and after-care in cases of illness, ambulance services, blood transfusion and laboratory services. (Special school health services are already provided for in the Education Act of 1944.) 4. The provision of spectacles, dentures and other appliances, together with drugs and medicines—at hospitals, Health Centres, clinics, pharmacists' shops and elsewhere, as may be appropriate. General Practimoner Services—Health Centres. A main feature of the personal practitioner services is to be the development of Health Centres. The object is that the Health Centre system, based on premises technically equipped and staffed at public cost, shall afford facilities both for the general medical and dental services and also for many of the special clinic services of the local health authorities, and sometimes also for out-post clinics of the hospital and specialist services. Besides forming a base for these services, the Centres will also be pble to serve as bases for various activities in health education. The Bill makes it the. duty of the county and county borough councils to provide, equip, staff and maintain the new Health Centres to the satisfaction of the Minister. The local authorities will directly administer such of their own local clinic facilities as they may provide in the Centres. Doctors and dentists, however, who use the new Centres while participating in the general personal practitioner service will be in contract only with the new Executive Councils, and it will be for those Councils to arrange with the local authorities for the use of the Centres' facilities by those doctors and dentists. 19 Local Government Services. This part of the health service comprises the local and domiciliary services which are appropriate to local government. The Bill unifies these services in the existing major local authorities—the county and county borough councils. For most of these services, the Bill requires the local health authorities to indicate to the Minister the way in which they intend to carry out their responsibilities, and it requires the Minister's general approval. (a) Maternity and Child Welfare and Midwifery. The Bill makes it the duty of every local health authority to make arrangements for the care of expectant and nursing mothers and of children under five years of age who are not attending school and who are therefore not covered by the school health service. Their arrangements will include ante-natal clinics for the care of expectant mothers, post-natal and child clinics, the provision of such things as cod liver oil, fruit juices and other dietary supplements and, in particular, a priority dental service for expectant mothers and young children. The Bill transfers these functions from such of the present "minor" authorities—the non-county boroughs and the district councils—as are at present exercising them. But, for coordination with the school health services, provision is made for delegating child welfare to " district executives " in the same way— and with the same rights for the minor authorities—as is done for the school health service under the Education Act, 1944. The same authorities— county and county borough councils—are also made the supervising authorities for the purposes of the existing Midwives Acts; that is to say, they are made responsible for a complete midwifery service for mothers who are confined at home. Mothers who for any reason have their confinements in a hospital or maternity home will be in the care of the hospital and specialist service. It will also be the object of that service to provide locally for all specialist obstetric or gynaecological care which may be needed in relation to the ordinary domiciliary service of the local authority. The requirements of Ministerial approval to the local authority's arrangements will link together the two aspects of the maternity service— domiciliary and institutional. 20 (b) Health Visiting and Home Nursing. It is made the duty of the local health authority to provide for a full health visitor service for all in their area who are sick, or expectant mothers, or those with the care of young children. This widens the present conception of health visiting (as concerned with mothers and children) into a more general service of advice to households where there is sickness or where help of a preventive character may be needed. It is also made the duty of the local health authority to provide a home nursing service for those who—for good reason— need nursing in their own homes. In both of these activities the local authority can, if it likes and if the Minister approves, make all or part of its provision by arrangement with voluntary organisations to act on its behalf In July, the Council decided that accommodation be provided at the proposed new main health centre for the administrative offices of the Public Health Department, and also for the health centre facility proposals contained in the National Health Service Act; and in September the provision of six Subsidiary Health Centres was incorporated in the Council's long-term plan—the idea being that a Subsidiary Health Centre be incorporated in six of the eight "Neighbourhood Units" proposed in connection with the Council's town planning scheme. At the end of the year negotiations were taking place with regard to the acquisition of the sites. 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 2,947 Miscellaneous inspections 567 Re-inspections 9,078 Places of entertainment 9 21 Schools 18 Stables 15 Urinals 112 Visits in connection with infectious diseases 204 Factories without mechanical power 39 Factories with mechanical power 160 Rag and bone dealers 6 Foster-mothers' premises 13 Hairdressers'premises 42 Public Houses 15 Offensive Trades 106 Piggeries 24 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 538 Sashcords renewed 148 Plaster repaired 681 Roofs repaired or renewed 657 Guttering repaired or renewed 357 Yards paved 27 Drains relaid or partly relaid 87 Choked drains cleared 81 New w.c. pans and traps provided 137 Sinks provided 44 W.c. cisterns repaired or renewed 137 Rain water pipes repaired or renewed 234 Vent pipes repaired or renewed 63 Sink waste pipes repaired or renewed 129 Stoves repaired or renewed 373 Coppers repaired or renewed 25 Floors repaired 341 Rooms redecorated 553 Windows, sills, etc., repaired 310 Cement work to sink waste gullies repaired 86 Miscellaneous defects remedied 572 Verminous Houses. Number of houses Infested. Disinfested. 180 180 22 Rats and Mice (Destruction) Act, 1919. Ministry of Food—Infestation Order 1943 S. R. & O. 680. Special Scheme. The house-to-house survey of the Borough under the terms of the Ministry of Food's Circular N.S. 12 commenced in October, 1946, but the staff necessary could not be obtained until the end of November. Four operators and four investigators are employed in this work, which it is hoped will be completed by the end of June, 1947. Premises visited 6,382 Premises reported infested 196 Premises treated :— (a) Dwelling-houses 149 (b) Business premises 32 181 Casual Complaints (not included in Special Scheme). Complaints received and investigated 382 Premises not treated (not genuine infestation) 29 Premises treated :— (а) Dwelling-houses 297 (б) Food premises 24 (c) Other business premises 32 353 Premises freed 321 Sewer Maintenance Treatments. All sewers in the Borough were treated in May, 1946 (followed by a further treatment in February, 1947). General. Treatments have been carried out with success on the Corporation's properties and schools. The refuse destructor works and adjoining land and buildings on the west side of the Borough, to the allotments at Lammas Road, were badly infested and inspection after treatment has shown that practically complete disinfestation has been accomplished. The control of rats demands continued investigation and treatment of reservoirs of infestation such as the sewers, tips and river banks, etc. The chief source of surface infestation is the sewers and defective connected drains. The relaying of defective drainage systems was greatly reduced during the war years, but this essential work is now proceeding as fast as the shortage of materials and labour permits. 23 HOUSING. Complaints. During the year 2,314 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 1,331 Statutory— Housing Acts Nil Public Health Acts 425 Notices complied with—Informal 1,234* Statutory- Housing Acts Nil Public Health Acts 85 *This figure includes notices outstanding from previous year. Housing. Number of houses erected during the year :— (a) Total (including numbers given separately under (6)). (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons: Houses Nil Flats Nil (b) With State assistance under the Housing Acts. (i) By the Local Authority :— (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 dubing the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,947 (6) Number of inspections made for the purpose 9,645 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 Nil (6) Number of inspections made for the purpose Nil 24 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,331 II.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action taken by the Local Authority or their officers 1,234 III.—Action under Statutory Powers during the Year:— (а) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (а) By owners Nil (б) By Local Authority in default of owners Nil (б) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 425 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 185 (б) By Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act 1936:— (1) Number of dwelling-houses in respect of which demolition orders were made Nil (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil 25 (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 Landlord and Tenant (War Damage) Acts, 1939-1941. Three applications were received from owners of houses for "Certificates of fitness." Three certificates were issued. Housing Act, 1936. Information regarding 461 houses and 37 flats was supplied in connection with the "permitted number of persons" in dwellings under the Act. Local Land Charges. Particulars with regard to outstanding sanitary notices, not fully complied with, were given in reference to 1,109 enquiries. INSPECTION AND SUPERVISION OF FOOD. Inspections. The following visits were made to food premises during the year :— Slaughter-houses 39 Butchers 235 Bakehouses 88 Fishmongers 125 Milkshops and dairies 118 Provision shops 448 Dining rooms 196 Greengrocers 140 Fish friers 61 Meat Depots 9 Ice cream premises 260 26 MILK. Dairies and Milkshops. 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 1 Premises removed from register during year 1 Visits of inspection 118 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 19 19 - 12 7 Supplementary Licences - - - - - - Tuberculin Tested 2 - - - - - Pasteurised 3 - - - - - Totals 34 19 19 - 12 7 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1946 67 Premises registered during 1946 Nil Premises removed from Register during 1946 Nil MEAT. Slaughter - Houses.—There are six licensed slaughterhouses in the Borough, and 39 inspections of these slaughterhouses were made. Meat and Foods condemned and destroyed. Meat 1,113 lbs. Fish 806 „ Fats 73 ,, Cheese 70 „ Sugar 1,671 ,, Dried Fruit 281 „ 27 Tea 38 lbs. Sweets 54 „ Eggs 411 Pickles, vinegar, etc. 14 bottles Jam and marmalade 69 lbs. Bread 210 Qtns. Tinned foods 8,381 tins Bitter Orange Pulp 324 lbs. Peaches 10 boxes Miscellaneous foods 60 packets Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 6 Dairies, Milkshops and Dairymen 181 Butchers'shops, Stalls and Provision shops 300 Hairdressers' Premises 68 Fish friers 19 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 licenses during the year. Cattle Pens, Temple Mills Railway Siding. Every endeavour was made to ensure early removal of animals from the sidings. 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 142. 28 Samples analysed Samples unsatisfactory. Milk 36 1 Apples in bottle 1 — Apple juice 1 — Arrowroot 1 — Baking powder 1 — Baker's moistener 1 — Black pudding 1 — Butter 2 — Cake filling 2 — Carrot juice 1 — Chocolate spread 1 — Cocoa 1 — Coffee 1 — Curry powder 2 — Cinnamon, ground 1 — Cooking fat and nutter fat 2 — Cordial (ginger flavour) 1 — ,, (lemon flavour) 1 1 ,, (lemon squash) 1 — Dessert mould 1 — Effervescent drink 1 — Flavouring powder 1 — Fish paste 2 — Gelatine 5 — Ginger 1 — Herbs, mixed 1 — Jelly 1 — Jelly creme 1 1 Jelly dessert 1 1 Lemon flavoured crystals 1 — Lemon squash 1 — Lemonade crystals 1 — Jam 1 — Malt cocoa spread 1 — Margarine 2 — Mustard 1 — Nutmeg, ground 1 — Orange flavouring 1 — ,, marmalade 1 — Peanut butter 1 — 29 Samples analysed. Samples unsatisfactory. Pepper 5 — Peppermint flavouring essence 1 — Piccalilli 1 — Sauce 1 — Sausages 12 — Sausage meat 2 — Semolina 1 — Spice, mixed 1 — Soup, desiccated 1 — Soya nut 1 — Sponge mixture 1 — Sponge pudding mixture 1 — Table dessert 1 — Table jelly 1 — Tart fruits (apples) 1 — Vi-Cocoa 1 — Vinegar 8 1 Aspirin tablets 2 — Bicarbonate of Soda 2 — Boracic ointment 1 — Cascara sagrada 1 — Cough lozenges 1 — Glycerine 3 — Lanoline 1 — Lung syrup 1 — Saccharin tabelts 1 — Sulphur Ointment 2 — Vitamin tonic 1 1 Zinc ointment 1 — 142 6 Legal Proceedings. Food and Drugs Act, 1938. Sweet pickle unfit for human consumption:— Case dismissed on payment of two guineas cost. 30 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. (I) (2) (3) (4) Factories with mechanical power 260 17 - Factories without mechanical power 39 2 - Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) - - - Total 299 19 - 2. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) Lack of cleanliness 1 1 - Sanitary Conveniences:— Insufficient 1 1 - Dirty - - - Other Offences - - - Total 2 2 - OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937.) Nature of Work. Instances. Notices served. Prosecutions (1) (2) (3) (4) Nil Nil Nil - 31 MATERNITY AND CHILD WELFARE. INFANT WELFARE. Notification of Births.—Two thousand one hundred and fifty-seven notifications of births were received during the year. By medical practitioners 498 By midwives 1,659 By parents and others - During the year under review, the total attendances at the Council's Infant Welfare Centres were 17,915, an increase of 4,340 compared with the figure (13,575) for the previous year. The number of children examined by the Clinic Medical Officers was 4,438 as compared with 4,254 examined during the previous year. Health Visitors. During the year the Health Visitors have made 11,690 visits to homes, as follows:— (а) To expectant mothers:— First visits 122 Total visits 124 (b) To children under 1 year of age:— First visits 2,112 Total visits 6,477 (c) To children between the ages of 1 and 5 years:— Total visits 5,089 32 TABLE 7. ATTENDANCES, EXAMINATIONS, etc., 1946. Leyton Green. Park House. All Centres. Under 1 year— 1st attendances 826 682 1,508 Subsequent attendances 6,885 5,930 12,815 Total attendances 7,711 6,612 14,323 1-5 years— 1st attendances 76 75 151 Subsequent attendances 1,587 1,854 3,441 Total attendances 1,663 1,929 3,592 Total attendances, both age groups 9,374 8,541 17,915 Average attendance per session 62,79 67,32 59,71 Number examined by clinic doctor 2,237 2,201 4,438 Number weighed 9,368 8,539 17,907 33 Dental Treatment. Expectant others. Children Patients treated 172 188 Attendances 452 291 Extractions 927 319 Fillings 118 110 Other dental operations 181 45 Advice only 87 61 Anaesthetics- General 117 125 Local 148 8 Dentures supplied— Full upper and lower 9 Full upper 4 Full lower 1 Full upper and partial lower 3 Partial upper 1 Partial upper and lower 1 19 Orthopaedic Treatment. Primary Examinations.—During the year 12 children were referred from the Infant Welfare Clinics to the Council's Orthopaedic Surgeon. Re-examinations.—In addition to the 12 new cases mentioned above, 24 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—Sixty-eight children made 484 attendances for special treatment by the Council's Masseuse (Miss Findlay). Provision of Surgical Appliances.—Forty-eight children had minor alterations to boots and shoes and one child was supplied with iron tunnel and T-straps to boot. 34 Special Eye Clinic. The Council's Ophthalmic Surgeon had referred by the Clinic Medical Officers 128 pre-school children, who made 176 attendances for examination and treatment. Artificial Sunlight Treatment. Number of cases treated 74 Total number of attendances 1,571 Convalescent Home Treatment. Children. Two children recommended by the Clinic Medical Officers were sent to Convalescent Homes by the Maternity and Child Welfare Authority. 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 At Home. In Hosp. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. 4 2 2 4 - - - Infant and Foetal Mortality. The following figures show the variations in the infantile and neo-natal mortality rates, and in the number of stillbirths during 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. Neo natal. (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) 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 1946 2,223 64 47 28.78 21.14 53 23.24 TABLE 8. Infantile Mortality, Year 1946—Ages. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Smallpox ... … ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... 1 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... 1 ... ... 1 Diphtheria and croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... ... 1 Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... 1 ... ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) 1 2 1 1 5 1 1 2 2 11 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... 3 ... ... 3 ... 1 ... 1 5 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 6 2 1 ... 9 ... ... ... ... 9 Congenital malformations 8 2 ... 1 11 1 1 1 ... 14 Premature birth 18 ... ... ... 18 ... ... ... ... 18 Atrophy, debility and marasmus 1 ... ... ... 1 ... ... ... ... 1 Other causes ... ... ... ... ... 1 ... i ... 2 Totals 34 9 2 2 47 3 5 6 3 64 Nett Births registered during the calendar year Legitimate 2,,137 Nett Deaths registered during the calendar year Legitimate infants 62 Illegitimate 86 Illegitimate infants 2 35 36 TABLE 9. Infantile Mortality During the Year 1946—Wards. CAUSE OF DEATH. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward not known. Total Deaths under 1 Year. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... ... ... 1 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... 1 ... ... ... ... Diphtheria and croup ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... 1 ... ... 1 Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... ... 1 ... ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) 1 2 1 1 1 ... 1 2 2 ... ... 11 Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... 1 1 ... 1 1 1 ... ... 5 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... 1 1 3 1 ... 2 1 ... ... 9 Congenital malformations 2 ... 4 ... 3 1 ... 3 ... 1 ... 14 Premature birth ... 2 4 2 3 2 2 ... 3 ... ... 18 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... 1 ... ... 1 Other causes ... 1 ... ... ... 1 ... ... ... ... ... 2 Totals 3 5 10 5 11 5 4 11 9 1 ... 64 37 Public Health Act, 1936. Child Life Protection. On 1st January, 10 foster mothers and 11 children—and at the end of the year 8 foster mothers and 8 children—were subject to inspection. The Council's Child Protection Visitors made 58 visits of inspection during the year. Summary, Year 1946. Number of nurse children on Register, 1st January 11 Number of nurse children notified by foster mothers during the year 12 Nurse children removed:— To parents or relatives 5 Adopted 2 To institutions 2 Attained 9 years of age 1 To another foster mother 2 Removed from district 3 Number of nurse children on Register on 31st December 8 MATERNAL WELFARE. Ante-Natal Clinics— Attendances.— First Attendances. Subsequent Attendances. Total. 801 1,407 2,208 The average number in attendance at the Ante-Natal Clinics held at the Council's two Centres during 1945 was 13.63 per session. The number of home visits made by Health Visitors to expectant mothers during the year was 124. Maternity Beds. One thousand and five patients were admitted during 1946 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. Seven inspections were made to these institutions during the year. 38 Puerperal Pyrexia. Twenty cases of puerperal pyrexia were notified during the year. The causes of pyrexia were considered to be:— Urinary infection 3 Broncho-pneumonia 1 Not known 9 Influenza 2 Pyelitis 1 Retained placenta 1 Organisms other than hæemolytic streptococci 3 20 Obstetric Consultant. The advice of the Council's Consultant Obstetrician was sought on four occasions 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 Mid wives' Board, a midwife must notify the Local Supervising Authority within 36 hours of every occasion on which she sends for medical aid. Three hundred and twenty-seven such notifications were received. Fees paid to Doctors. Two hundred and seventy-five 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 £419 9s. 6d. 39 Post-Natal and Gynaecological Clinic. Leyton Green Health Centre. Number of Sessions 18 Letters of Invitation 274 First Attendances 157 Re-attendances 116 Report by Dr. Anne S. Clark, M.B., Ch.B. During the year 18 sessions of the Post-Natal and Gynaecological Clinic were held. The number of new patients who attended was 157, out of 274 who received appointments to attend (= 66 per cent.). Of these, 119 were post-natal (i.e., they had had confinements within the previous three months); and 38 were gynaecological. The disposal of these cases was as follows:— Discharged after one "attendance 76 Re-attended for examination and treatment 81 The total number of attendances was 273. The average attendance per session was 15.16—with a maximum of 22 and a minimum of 8. Free medical prescriptions were issued in 65 cases at a total cost of £17 12s. 2d.; and 13 prescriptions were issued for payment by the patients. The following are the main conditions which have been found on examination:— Subinvolution of the uterus 14 Cystocele and rectocele 5 Retroversion of uterus 16 Anaemia 4 Defective perineum 8 Cervical erosion 4 Vaginitis 1 Sterility 3 Fibroid 3 Birth control 39 40 Record of Cases attended by Council Midwives, 1946. Midwives employed by 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. Total Cases attended:— (a) As Midwives 264 552 816 (ft) As Maternity Nurses 48 68 116 Ante-natal Visits 620 2,628 3,248 Ante-natal Examinations 2,714 5,354 8,068 Post-natal Visits 5,656 11,710 17,366 HOME HELPS SERVICE. Historical Summary. Since the year 1931 there has been in operation in the Borough a scheme for the provision of home helps during the confinement or incapacity, due to obstetric reasons, of the mothers of households. From that time until 1938 the chief difficulty in operating the scheme was the difficulty in obtaining enough experienced and reliable women who were willing to have their names put on the Council's list of approved home helps owing to the spasmodic and casual nature of the employment, which was not of the nature likely to attract the best type of woman. In 1938 the Council therefore adopted a scheme whereby applicants could employ home helps of their own choice. Grants of financial assistance by the Council were subject to the Council's being satisfied with the home help and her work. Ministry of Health Circular 179/44 (December, 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 41 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 application 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, in April, 1946, the Maternity and Child Welfare Authority conferred with representatives of the local Women's Voluntary Service organisation and the following proposals were agreed:— (a) That the Women's Voluntary Service undertake the following duties:— (i) To organise propaganda making the scheme known. (ii) To interview applicants for the position of Home Help, take up references, etc., and pass details to the Medical Officer of Health, who will engage applicants at his discretion. (iii) To interview applicants for Home Helps. (b) That the Council should:— (i) Appoint a full-time clerk to be employed at the office of the Women's Voluntary Service. (ii) Advertise in the local Press inviting applications for the position of Home Help. In June the Council decided:— (а) to appoint two full-time Home and Domestic Helps, to be paid at the rate of 1s. 9¾d. per hour; (b) that additional full-time Home and Domestic Helps be appointed should the demand justify additional appointments; and (c) that, in the event of the services of a Health Visitor not being available, a Case Visitor be appointed at the appropriate salary. 42 In July it was decided that the scale of recovery from householders be calculated in accordance with the Council's scale of necessity. A temporary full-time clerk was appointed on the staff and under the jurisdiction of the Medical Officer of Health at a salary of £3 10s. Od. per week, plus bonus. The Council also decided that their existing Home Helps Scheme, whereby applicants supply their own Home Helps, be discontinued forthwith, with the exception of cases already booked. On 29th July, the Domestic and Home Help Office opened at 267, High Road, Leyton, and the full-time clerk commenced duty. In August, all doctors and midwives practising in the Borough were circularised with particulars of the Service, and the three local papers inserted a summary of the Service. On 12th August, the Case Visitor and two full-time Helps commenced duty. A summary of the period 12th August to 31st December, 1946, is as follows:— Helps as at 31st December, 1946. Full-time 3 Part-time 10 During this period there were 417 enquiries in respect of the Domestic and Home Help Service; 190 bookings had been accepted in respect of Home Helps; and 22 in respect of Domestic Helps. Completed cases during the period consisted of 50 Home Help cases and 12 Domestic Help cases. NURSERY PROVISION FOR CHILDREN UNDER FIVE. Extracts from Joint Circular from Ministry of Health (Circular 221/45) and Ministry of Education (Circular 75). Post-war Needs. With the cessation of hostilities and the passing into law of the Education Act, 1944, it was contemplated that the nurseries which were established specially for the war-time purposes mentioned would gradually cease to function as such; that concurrently there would be a considerable expansion of nursery schools and nursery classes; and that, in exercising their powers to provide day nurseries, welfare authorities would avoid overlapping with or prejudicing that expansion. 43 The Ministers concerned accept the view of medical and other authority that, in the interests of the health and development of the child no less than for the benefit of the mother, the proper place for a child under two is at home with his mother. They are also of the opinion that, under normal peace-time conditions, the right policy to pursue would be positively to discourage mothers of children under two from going out to work ; to make provision for children between two and five by way of nursery schools and nursery classes ; and to regard day nurseries and daily guardians as supplements to meet the special needs (where these exist and cannot be met within the hours, age, range and organisation of nursery schools and nursery classes) of children whose mothers are constrained by individual circumstances to go out to work, or whose home conditions are in themselves unsatisfactory from the health point of view, or whose mothers are incapable for some good reason of undertaking the full care of their children. The Ministers recognise, however, that this policy represents an ideal which cannot be immediately attained. The period of transition from war to normal peace-time conditions is likely to be substantial; during that period, in some areas, the need for women workers in industries vital to production for essential home requirements or for export may well be as urgent and important to the national interest as it was for war production; and housing and shopping difficulties will continue, though they will progressively diminish. Moreover, it has been represented that nursery schools and nursery classes will never wholly meet the need because they do not admit children under two (or three) years of age, and are open only during school time ; and that some permanent provision may need to be made for the occasional care of children of all ages up to five in order that all mothers, whether or not they go out to work, may have reasonable opportunity of rest and relaxation apart from their homes and children. Measurement of Local Need and Provision for meeting it. The measurement of local need, and the selection and operation of the best methods of meeting it, both immediately and in the more distant future, must, therefore, rest primarily on the local authority or authorities concerned. As regards methods, what is required, for the time being at all events, 44 is a combination appropriate to local needs and circumstances, of nursery schools, nursery classes, day nurseries, and also organisations of daily guardians administered by the welfare authority and supervised by their health visitors, using existing services as a foundation. Co-operation between Local Education Authorities and Welfare Authorities. Since the provision to be made is a combination of measures, some of which are within the province of the local education authority and others within that of the welfare authority, the planning of future arrangements must be undertaken jointly by the two authorities working in collaboration. In some Counties and in County Boroughs this should create no difficulty, since the Council is both the local education authority and the welfare authority for the whole of its area. In Counties where the County Council is not the welfare authority for the whole of the County the County Council should take the initiative and invite the welfare authorities to co-operate with the County Council in the preparation of the scheme. The first step will be to review the war-time nurseries now in operation ; to consider, with due regard to the extent to which women are likely to continue to be required in essential industries in the area and to the numbers and ages of the children on the nursery registers and to the suitability of the premises— (a) which of these nurseries should continue to be run under maternity and child welfare powers by the welfare authority; (b) which of them should be taken over and run as nursery schools or nursery classes by the local education authority ; and (c) which of them should be closed on the ground that they are surplus to requirements The extent to which nurseries which are to be continued as nursery schools or nursery classes or day nurseries need to be supplemented, or those which are closed can be replaced, by a system of registered and supervised daily guardians and/or by the opening of afternoon creches at maternity and child welfare centres, should be determined at the same time. 45 Submission of Local Scheme for Approval. When the scheme, to operate from 1st April, 1946, has been formulated the welfare authority should submit it, on form to be supplied shortly, to the Minister of Health for approval under Section 204 of the Public Health Act, 1936 (Section 251 of the Public Health (London) Act, 1936). Categories of Children to be Admitted to Day Nurseries. Local authorities should take into account, in formulating their schemes, the needs of mothers who do not go out to work as well as of those who do. So far as day nurseries (as distinct from other measures) are concerned, the practical difficulties in the way of maintaining the existing number of places, let alone increasing it, will make it necessary to continue to give preference to the children of mothers who are employed in industries which are vital to production for essential home needs or for export, or of mothers who are ill or being confined, or of employed unmarried mothers who are anxious to keep their babies with them, but cannot do so without some provision for the babies' care during the day, etc. Subject to this, such vacancies as exist may be filled at the local authority's discretion, and the limitations which operated in war-time may be regarded as withdrawn. Payments by Mothers. Up to 31st March, 1946, mothers' contributions to the cost of day nurseries or registered daily guardians should continue on the existing basis. As from 1st April, 1946, the existing charges may be raised at the discretion of the welfare authority. • Existing Staff. Appropriate members of the staff, excluding State Registered and other hospital trained nurses, may be transferred with such nurseries as are taken over by the local education authority for use as a nursery school or class. As however, the number of staff in a war-time nursery will usually be in excess of the needs of a nursery school or class, it is essential, in view of the general shortage of trained and experienced nursery staff, that arrangements should be made beforehand to transfer redundant staff to other nursery work elsewhere before the nursery begins to function as a nursery school or class. 46 Staffing of Day Nurseries : Ratio and Remuneration as from 1st April, 1946. The Exchequer grant will be payable as from 1st April, 1946, on the basis of (i) the existing ratio of full-time staff (including a warden, but excluding domestic staff) of one to five children on the register, and (ii) the existing rates of pay in war-time nurseries, subject to any modifications which may subsequently be recommended. In training nurseries three probationers will count for the purposes of the ratio referred to, as the equivalent of one member of staff. After consideration of above Joint Circular, and the report of the Medical Officer of Health thereon, the Council decided that; as from 1st April, 1946, the two existing War-time Nurseries should continue to be administered by the Welfare Authority; that a Joint Committee of representatives of the Maternity and Child Welfare Committee and of the Ley ton Interim Education Committee be set up to consider future policy with regard to nursery provision for children under five years; that the charges should continue at the existing rate of 1s. per day in respect of each child attending a nursery; and that the question of the categories of children to be admitted should be def rred pending the submission of observations. by the Medical Officer of Health on the matter. Report by the Medical Officer of Health (March, 1946). 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 47 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. 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. 48 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 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 expression of opinion ; and the only "yardstick" available at the present time for the assessment of health in young' children is gain in weight. In order that your Committee should have at your disposal all availabe information before you decide on the categories of children to be admitted to your day nurseries after 1st April next I have asked Dr. Menzies to submit her observations. 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 49 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 lb., so that these gains appear to be at the lower limit of normality. Gains in weight in Age on Admission. 3 months. 3-6 months. 0-12 months. Ellingham Road 25 lb. 14 oz. 23 lb. 6 oz. 48 lb. 12-18 months 26 20 9 —1 lb. —1.17 1b. —5.3 lb. Knotts Green 45 lb. 34 lb. 8 oz. 82 lb. 12-18 months 32 24 16 —1.4 lb. —1.34 lb. —5.121b. Ellingham Road 22 lb. 6 oz. 10 lb. 13 oz. 12 lb. 14 oz. 18-24 months 15 10 3 —1.49 lb. —1.08 lb. -4.29 lb. Knotts Green 25 lb. 15 oz. 27 lb. 5 oz. 55 lb. 18-24 months 27 20 11 —.96 lb. —1.38 lb. —5 lb. 50 So far I have attempted only 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. 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. 51 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 child to the nursery. If the mother is seriously ill, day nursery provision is not adequate, and in any case 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. After consideration of that report the Welfare Authority decided that, during the period of transition from war to normal peace-time conditions, preference be given to the children of:— (i) employed unmarried mothers who wish to keep their babies with them when not at work; (ii) employed widows; (iii) mothers employed in industries vital to production for essential home needs and for export; and (iv) mothers who are ill or being confined. 52 In July, as the result of certain difficulties in the rigid application of that scheme of priority in the admission of children, it was decided that category 2 should include mothers divorced from, separated from or deserted by their husbands; and that motherless children be placed in category 1. Joint Committee. In accordance with the recommendation contained in the Joint Circular from the Ministry of Health (221/45) and the Ministry of Education (75), in January the Council set up a Joint Committee of representatives of the Maternity and Child Welfare Committee and the Education Committee to consider future policy with regard to nursery provision for children under five years. At their meeting in February this Joint Committee decided on the following estimate of the number of children for whom it is anticipated that nursery accommodation will be required:— Under 2 years 60 children Between 2 and 5 years 150 children As a matter of long-term policy, the Education Authority's proposals are for the establishment of five nursery schools for children from 2 to 5 years of age. 53 TABLE No. 10. WAR-TIME DAY NURSERIES — AVERAGE DAILY ATTENDANCE, J 946. 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 9.39 22.34 1.00 5.25 31.73 6.25 11.73 28.56 3.25 5.50 40.29 8.75 February 12.45 30.55 2.25 10.50 43.00 12.75 11.80 31.80 2.25 6.75 43.60 9.00 March 12.04 34.57 2.60 7.60 46.61 10.20 11.19 32.52 1.00 8.50 43.71 9.50 April 12.00 35.70 2.00 6.33 47.70 8.33 11.25 31.10 0.00 9.00 42.35 9.00 May 7.56 26.65 0.50 6.75 34.21 7.25 9.30 30.56 0.50 8.25 39.86 8.75 June 10.00 27.42 2.33 11.00 37.42 13.33 6.10 28.94 0.00 5.75 35.04 5.75 July 11.95 37.17 4.75 9.75 49.12 14.50 4.69 29.73 0.00 3.50 34.42 3.50 August 10.23 36.80 3.75 9.25 47.03 13.00 7.90 29.04 0.00 2.75 36.94 2.75 September 9.57 37.23 3.50 11.00 46.80 14.50 12.52 38.80 0.00 2.00 51.32 2.00 October 10.08 40.17 4.00 9.25 50.25 13.25 11.43 44.69 0.00 2.00 56.12 2.00 November 9.04 37.85 2.60 6.80 48.89 9.40 12.23 40.57 0.00 1.80 52.80 1.80 December 6.65 33.20 1.66 6.33 39.85 8.00 7.75 36.25 0.00 1.75 44.00 1.75 Average for Year 10.08 33.30 2.57 8.31 43.38 10.88 9.82 33.54 0.58 4.79 43.36 5.37 54 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SMALLPOX. During the year no case of smallpox occurred in the area. Vaccinal State of Children examined at Routine Medical Inspection. All vaccination against smallpox is compulsory under the provisions of the Vaccination Acts; it has been realised for some time that a relatively small proportion of children are now being vaccinated. The following figures show the vaccinal state of children who have been examined at routine medical inspections during the last six years. Year Number Examined Number Vaccinated Percentage Vaccinated 1941 2,065 471 22.8 1942 3,010 539 17.9 1943 2,909 789 27.1 1944 2,688 691 25.7 1945 2,401 624 26.0 1940 3,344 988 29.5 Total 16,417 4,102 24.9 ENTERIC FEVER. During the year two cases of enteric fever occurred in the area. CEREBRO-SPINAL MENINGITIS. 3 cases were notified during the year. MEASLES. 439 cases of measles were notified during the year. WHOOPING COUGH. 155 cases of whooping cough were notified during the year. SCARLET FEVER. Year. Cases Notified. Deaths. Case Fatality per cent. 1942 318 0 0.00 1943 386 0 0.00 1944 110 0 0.00 1945 312 0 0.00 1946 201 0 0.00 55 DIPHTHERIA. Year. Cases Notified. Deaths. Case Fatality per cent. 1942 39 0 0.00 1943 28 1 3.57 1944 24 1 4.16 1945 43 2 4.6 1946 38 1 2.6 ARTIFICIAL IMMUNISATION AGAINST DIPHTHERIA. Immunisation by Private Medical Practitioners. Number of private medical practitioners who applied for supplies of toxoid-antitoxin 20 Number of children immunised 54 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. RETURN THE YEAR 1946. Age 0-5 years. Age 5-15 years. Total. 1. Number of children who completed the course of immunisation during the year 1,422 170 1,532 2. (a) Approximate estimated child population at end of year 7,890 11,610 (b) Percentage of child population considered to be immunised at end of year 52.48 69.27 The above Return—Section 2 (b)—shows the percentage of the child population considered to be immunised. As these percentage figures are calculated on the estimated child population, they are liable to a considerable margin of error. In order to verify or otherwise the accuracy of these percentage figures, since 1944 it has been the practice for records to be kept of the state of immunisation against diphtheria of all children submitted to routine medical examination in school; and the following table shows the percentages of immunised children in the three code groups of children inspected in school during each of the last three years. 56 Percentage of School Children Immunised. Entrants Second Age Group Third Age Group No. Exmd. No. Immunised % No. Exmd. No. Immunised % No. Exmd. No. Immunised % 1944 1,282 922 71.9 647 513 79.0 759 470 61.9 1945 093 487 70.2 965 779 80.7 743 561 75.5 1946 1,240 919 74.1 1,191 889 74.6 913 634 69.4 Incidence of Diphtheria Among Protected Persons. During 1946 seventeen 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. 2 F 30.4.45 14.1.46 N — T — Non-specific tonsillitis 8 M 22.6.43 28.1.46 — 5 M 30.12.42 15.3.46 — Tonsillitis 7 M 25.2.43 19.3.46 N — T — Ulcerated Tonsillitis 7 F ? 12.4.46 — Tonsillitis 3 M ? 16.4.46 — Not diphtheria 6 M 19.11.41 8.5.46 N — T — Common cold 2 M 11.9.45 19.5.4-6 T — S1. septic tonsillitis 3 M 11.9.44 20.6.46 T — Mildfaucialdiphtheria 7 M 19.6.41 8.7.46 N — T — Tonsillitis 8 F 4.11.42 14.8.46 N — T — ,, 8 M 6.6.44 16.8.46 T 4 F 26.10.43 26.8.46 N — T — ,, 14 M ? 10.10.46 — „ 12 M ? 21.11.46 — Non-specific tonsillitis 11 M 8.8.39 13.12.46 T + Mild diphtheria 2 M 20.11.45 16.12.46 T — Acute pharyngitis TUBERCULOSIS. Notifications.—One hundred and eight patients were notified for the first time in 1946 as suffering from tuberculosis. The number was made up as follows:— Males. Females. Total. Pulmonary Tuberculosis 61 30 91 Non-Pulmonary Tuberculosis 6 11 17 67 41 108 57 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1946:— Pulmonary. Non-Pulmonary. total M. F. Total. M. F. Total. Number on Register at commencement of year 325 234 559 36 45 81 640 Number first notified during the year 61 30 91 6 11 17 108 Number of cases entered in Register otherwise than by Notification 21 23 44 2 4 6 50 Number removed from the Register during the year 111 100 211 22 21 43 254 Number remaining at the end of the year 296 187 483 22 39 61 544 Details of cases removed from the Register during the year:— Died 40 26 66 4 6 10 76 Removed from the district 57 52 109 13 10 23 132 De-notified 14 22 36 5 5 10 46 Deaths.—Forty-seven 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 4 — 1 1 5 0 — — 3 10 1 1 2 — 15 4 4 — — 20 7 7 1 — 25 14 13 1 2 35 9 4 — 3 45 11 1 — 1 55 6 — 1 — 65 and upwards 2 — — 1 Totals 61 30 6 11 58 Institutional Treatment. During 1946 the following Leyton patients were sent to sanatoria or other institutions for the treatment of Tuberculosis:— Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. Adults 20 37 4 6 67 Children 4 1 1 3 9 59 • TABLE No. 11. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1946. DISEASE. At All Ages Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and up Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 38 ... 2 4 4 3 13 7 1 4 ... ... ... Erysipelas... 24 ... ... ... ... ... ... ... ... 4 5 8 7 Scarlet Fever 201 2 5 10 16 25 96 30 5 9 3 ... ... Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 91 1 2 2 1 ... 2 2 9 39 13 19 1 T.B. Others 17 ... 1 ... 1 ... 3 2 ... 4 3 2 1 Pneumonia 141 6 4 3 5 5 16 1 2 16 26 36 21 Ophthalmia Neon. 4 4 ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever ... 2 ... ... ... ... ... ... 1 ... 1 ... ... ... Paratyphoid Fever 1 ... ... ... 1 ... ... ... ... ... ... ... ... Puerperal Pyrexia 20 ... ... ... ... ... ... ... ... 19 1 ... ... Cerebrospinal Meningitis 3 ... 1 1 ... ... 1 ... ... ... ... ... ... Poliomyelitis 3 ... 1 ... ... ... 1 1 ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery... 26 3 5 5 2 1 4 ... ... 3 2 ... 1 Measles 439 10 61 75 66 63 146 16 2 ... ... ... ... WhoopingCough... 155 22 22 23 24 19 43 2 ... ... ... ... ... Malaria 3 ... ... ... ... ... ... ... ... 1 2 ... ... Totals 1,168 48 104 123 120 116 325 62 19 100 55 65 31 60 TABLE 12. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1946. DISEASE. Total. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 38 1 8 4 1 14 0 0 3 1 2 37 Erysipelas 24 3 2 4 2 5 6 1 1 ... ... 12 Scarlet Fever 201 14 40 17 19 34 26 13 23 ... 7 84 Pemphigus Neon ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 91 5 15 3 11 19 14 6 3 11 4 ... T.B. Others 17 5 ... 1 ... 2 2 3 1 ... 2 ... Pneumonia 141 12 22 11 25 29 10 7 10 11 4 76 Ophthalmia Neon. 4 2 ... ... ... 2 ... ... ... ... ... 2 Typhoid Fever 2 ... ... ... 1 ... ... ... 1 ... ... 2 Paratyphoid Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 Puerperal Pyrexia 20 2 6 1 1 3 3 1 ... ... ... 13 Cerebrospinal Meningitis 3 ... ... ... ... ... 2 ... ... ... 1 2 Poliomyelitis 3 1 ... ... ... ... 1 ... ... ... ... 2 Enc. Lethargiea ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 26 ... 1 4 5 11 ... 4 ... 1 ... 23 Measles 439 58 156 37 37 80 34 4 19 11 3 19 Whooping Cough... 155 26 33 14 20 30 20 1 6 ... ... 27 Malaria 3 ... 1 ... ... 2 ... ... ... ... ... 2 Total 1,168 129 234 96 123 232 120 42 67 52 23 302 61 REPORT BY THE MEDICAL OFFICER OF HEALTH ON CERTAIN ASPECTS OF INFECTIOUS DISEASE CONTROL. "A practice or tradition in regard to a particular disease all too readily becomes established, fixed and static; yet scientific measures of disease prevention continually call for critical re-examination as to their truth and necessity, and for vigilant reconsideration from the point of view of the legitimacy and expediency of the expenditure incurred Sir Geo. Newman, Formerly Chief Medical Officer, Ministry of Health. During the lifetime of most of us the nature of the commoner notifiable infectious diseases, and available knowledge of their epidemiology, have undergone profound change; but no corresponding change has taken place either in the attitude of the general public towards infectious diseases or in the measures applied by Local Authorities to control them. For instance, the young fathers and mothers of to-day have had the information handed down from their parents that scarlet fever is a serious infection requiring six weeks detention in hospital; that "the measles" is/are a trivial complaint "the sooner over and done with the better"; that invisible germs "hang on" not only to objects handled by the infectious patient, but also to the very furniture and walls of the rooms he occupied; that everything is all right after the house has been "fumigated by the Council"; that children (generally some other parent's children) must not go to school if a case of fever is being nursed at home; that any person (other than a doctor or nurse), who has been in contact with a case of infectious disease, can "give it " to a third person; and so on. Towards the end of last century, owing to the high mortality and morbidity of scarlet fever and diphtheria, the public spirit was roused to carry on a thorough campaign with the avowed object of stamping out these and other forms of communicable disease. To combat the spread of infection fever hospitals were built for the segregation of the infectious sick ; the wholesale removal to hospital of all such patients was regarded as a necessary measure of control; and a most elaborate process of routine terminal disinfection was carried out on the assumption that the patient left behind him germs capable of conveying infection to other people. Leyton Temporary Isolation Hospital was built in 1896, and continued to serve the needs of the area until the outbreak 62 of war in 1939. In spite of the temporary nature of the structure, the inadequacy of the accommodation, the poor staff quarters, and the lack of a resident medical officer, the hospital was not only able to provide most forms of treatment available in more modern institutions, but valuable investigations were carried out there. One investigation was instrumental in drawing attention to the risk of aggregating scarlet fever patients in multiple-bed wards, in confirming the advisability of treating scarlet fever patients in separate rooms either at home or in hospital, and in showing that there is no increased risk to patients or contacts when isolation is carried out at home. At one time it was hoped that the segregation of infectious patients in hospital would help to eradicate these diseases, but such segregation for that purpose is now known to be ineffective—and infectious patients are now admitted to hospital more for treatment than for segregation. It will be seen from the following figures the great change which has occurred in the severity of these two diseases since the beginning of the present century. In order to save space, the annual figures relate to intervals of ten years until 1940, after which they are shown yearly. With regard to diphtheria, no death has occurred in a child who had previously been protected against that disease by artificial immunisation. Scarlet Fever Diphtheria Year No. of cases notified No. of Deaths Case fatality per cent. No. of Deaths. Case fatality per cent. 1900 243 7 2.8 224 28 12 5 1910 551 16 2.9 167 22 13.2 1920 450 5 1.1 354 27 7.6 1930 461 2 0.4 313 12 3.9 1940 87 0 0.0 55 0 0.0 1941 64 1 1.5 44 1 2.2 1942 318 0 0.0 39 0 0.0 1943 386 0 0.0 28 1 3.5 1944 110 0 0.0 24 1 4.1 1945 312 0 0.0 43 2 4.6 It is now known that, in normal times, from 4 to 5 per cent, of children are healthy "carriers" of diphtheria organisms, and that the percentage is much higher (as high as 12 per cent.) when diphtheria is epidemic. These "carriers" are apparently in good health; they do not show any sign or symptom of diphtheria, but they harbour in their noses or throats (or both) 63 virulent diphtheria organisms capable of conveying infection to susceptible contacts. Again, among apparently healthy children there are from 20 to 30 per cent. who are "carriers" of one or other of the 30 types of organism capable of causing scarlet fever. If the causative organism of scarlet fever happens to cause a rash, the patient is notified and dealt with as a case of scarlet fever. But if the same type of organism causes a sore throat without a rash (which is much more common) no official action is taken, although the case is equally infectious. The prevailing type of scarlet fever is so mild that the rash may last only a few hours. If the visiting doctor happens to call while the rash is "out" he will notify the case as one of scarlet fever. If he does not, the patient will be treated as a case of "sore throat". These are facts well known to, and acknowledged by, epidemiologists throughout the country; nevertheless we continue to spend valuable time and money in the perpetuation of routine measures of control which were instituted long before that knowledge was available. If it be considered to be necessary, as a measure of control, to isolate a person suffering from scarlet fever and diphtheria, it should be equally necessary to isolate all healthy "carriers " of these diseases. In 1930 I submitted to your Committee a report dealing with the laborious, expensive and ineffective practice of terminal disinfection; and, after consideration of that report, the routine removal of bedding and clothing for steam disinfection after the commoner infectious diseases was discontinued. Not only has that change of procedure saved much waste of time and money, but it has been accompanied by a fall—instead of, as some were disposed to fear, a rise— in the incidence of secondary cases per household ; and whereas in 1930 there were only two other areas in the country prepared to dispense with routine steam disinfection in dealing with the commoner infectious diseases, it is now becoming the common practice. In 1930, however, your Committee were not prepared to discontinue the spraying of rooms with liquid disinfectant, the reason given at that time being that "probably public opinion would be against such a wholesale change." I have therefore been obliged to continue, since that time, the carrying out of a form of ritual which can only give to householders a false sense of security. It is surprising to find how little is 64 claimed for fumigation, even by its most staunch advocates. Most take the view that, although it does no good, it can do no harm. Personally, I consider it can do serious harm; and there is no doubt that it gives to the public a false sense of security. I therefore recommend that your Committee consider again the advisability of discontinuing the spraying of premises with liquid disinfectant in order that the time and money so spent may be devoted to other more useful public health work. Before the war the Leyton infectious disease ambulance was stationed at the Isolation Hospital, where one of the three drivers (on eight-hour shifts) was on duty day and night. Two of these drivers were called up for military service, and since August, 1942, there has been available only one driver, who is on call day and night except when relieved on certain nights by a former fever ambulance driver who is now employed in the Public Health Department. Although the number of night calls has not been so great since the outbreak of war, the need for being on call day and night remains as before. The driver lives in Farmilo Road, and his relief driver in Norman Road. In the event of a sudden call during the night, the driver has to find his way from his home to the ambulance, which is stationed in an old garage in the Destructor yard ; and it will be appreciated that a motor ambulance (20 h.p.—six-cylinder) left in a cold garage may be very difficult to start-up in winter time. This arrangement cannot be regarded as other than unsatisfactory. Before the closure of Leyton Isolation Hospital at the outbreak of war a fever trained nurse, on duty in the ward to which the patient would be admitted, accompanied the fever ambulance. Until the disbandment of the Civil Defence Organisation last July a nurse or nursing auxiliary at High Road Baths First Aid Post acted as ambulance nurse. Since then, as no nurse is available, the patient's mother or other relative accompanies the patient to hospital. I have explored the possibility of establishing a roster of volunteers who would be prepared to act as ambulance nurses, but am not satisfied that the benefits which could possibly accrue from the operation of such a system would justify the delay which would be occasioned by getting into contact with the volunteers at short notice. 65 Your Council has a fleet of three civil ambulances under the control of the Highways Committee, and one fever ambulance under the control of the Public Health Committee. Although the same general medical practitioner may be visiting or attending accident, maternity and fever cases on the same round, it has generally been the custom for the vehicles and staff of civil and fever ambulance services to be quite separate organisations. Whereas it is conceivable that some risk might be incurred if, for instance, an expectant mother were transferred to a maternity hospital in an ambulance and by an attendant just returned from the conveyance of a scarlet fever or erysipelas patient without elementary precautions being taken, in my opinion the risk is so exceedingly remote as to justify the Council in giving consideration to the advisability or otherwise of providing two separate services administered and staffed by two differently constituted Committees. As the garages may soon have to be demolished to make room for the Ive Farm Depot of the Highways Committee, I suggest that the present would be an appropriate time to consider also the question of a combined service for the upkeep and maintenance of all motor transport under the control of the two Committees concerned. It is sometimes difficult to break with custom and tradition, and even more difficult to admit that public money may have been spent needlessly; but an honest endeavour to effect changes to meet changing circumstances is always more justifiable than expensive persistence on a set course merely because it happens to have been set by our predecessors acting on the knowledge then at their disposal. After consideration of above report, the Local Sanitary Authority decided— (a) That the routine spraying with liquid disinfectant of premises in which cases of the commoner notifiable infectious diseases have occurred, be discontinued; and that it be left to the discretion of the Medical Officer of Health to take such steps as he may consider necessary in individual cases. (b) That the infectious disease ambulance be incorporated in the Council's civil ambulance service, and that all proper precautions be taken in connection with special cases. 66 SCHOOL MEDICAL SERVICE. The figures set out below relate to the calendar year ended 1946. Number Roll Average Attendance Percentage of Attendance 1. Secondary Schools 14 3,217 2,960 92.01 2. Primary Schools 28 6,696 5,881 87.83 Totals 42 9,913 8,841 89.19 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 1,240 Second Age Group 1,191 Third Age Group 913 Total 3,344 Of 3,344 children who were examined in 'the code age-groups 2,895 (or over 86 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 3,564 comparing with 3,387 during the previous year. Re-inspections. The number of re-inspections during 1946 was 8,114. 67 The Findings of Medical Inspection. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups— Entrants 1,240 269 21.69 Second Age Group 1,191 305 25.61 Third Age Group 913 189 20.70 Total (Code Groups) 3,344 763 22.82 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 741 children were found to be unclean out of a total number of 21,134 examined (i.e., 3.5 per cent.) Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Exoluded. Canterbury Road 1,661 39 5 Capworth Street 1,713 48 15 Cann Hall Road 1,368 14 - Church Road 1,064 26 1 Connaught Road 1,165 27 2 Downsell Road 1,754 45 24 Davies Lane 1,310 35 8 Farmer Road 1.226 33 9 Goodall Road 1,384 52 15 Kirkdale Road 365 9 2 Lea Bridge Road 115 3 - Mayville Road 1,936 142 25 Norlington Road 1,281 29 15 Newport Road 2,252 67 9 Sybourn Street 1,227 17 1 St. Joseph's 257 5 5 Trumpington Road 827 3 - Knotts Green 144 10 1 Ley ton County High School 85 — — Total 21,134 604 137 Number of individual children found unclean 741 of whom 137 were referred to the Minor Ailments Clinics. 68 The incidence of uncleanliness for the past 10 years is shown in the following table. Year Number of Examinations Number Cautioned Number Excluded 1937 29,564 852 256 1938 29,763 1,133 252 1939 17,923 640 135 1940 9,871 504 160 1941 12,746 894 174 1942 17,439 794 196 1943 22,364 878 199 1944 18,090 841 160 1945 20,224 995 252 1946 21,134 604 137 199,118 8,135 1,921 69 Return of Defects found by Medical Inspection in the Year ended 31st December, 1946. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (6) Skin Ringworm—Scalp 1 ... 15 ... Body ... ... 11 ... Scabies 11 1 60 1 Impetigo 2 ... 55 ... Other diseases (non-T.B.) 18 2 1,203 ... Eye Blepharitis 9 ... 69 ... Conjunctivitis 5 ... 98 ... Keratitis ... ... ... ... Corneal Opacities 1 ... 1 1 Defective Vision 130 26 118 ... Squint 35 2 35 1 Other conditions 4 1 207 ... Ear Defective Hearing 16 6 29 ... Otitis Media 24 5 127 ... Other Ear Diseases 8 10 289 ... Nose & Throat Chronic Tonsilitis only 20 23 108 ... Adenoids only 16 14 9 ... Chronic Tonsilitis & Adenoids 37 52 41 ... Other conditions 43 12 356 ... Enlarged Cervical Glands (non-T.B.) 23 39 87 ... Defective Speech 2 2 12 ... Heart and Circulation Heart Disease— Organic. 3 3 8 ... Functional ... 11 5 ... Anaemia 4 2 46 ... Lungs r Bronchitis 34 18 86 ... Other non-T.B. Diseases 18 12 47 1 Tuberculosis Pulmonary— Definite 2 2 ... Suspected ... 6 8 ... Non-Pulmonary— Glands ... 2 5 ... Bones andjoints ... ... ... ... Skin 2 ... ... ... Other Forms ... 2 ... ... Nervous System Epilepsy 3 1 7 ... Chorea ... 1 8 ... Other conditions 14 10 80 ... Deformities Rickets 16 9 ... ... Spinal Curvature 17 ... ... ... Other Forms 169 18 76 1 Other Defects and Diseases 159 43 2,447 2 Totals 846 335 5,753 7 70 MEDICAL TREATMENT. Minor Ailments Clinics. ( Attendances. During the year 3,027 children attended the clinics, and 13,454 attendances were registered. Defective Vision.—Of the 3,344 children subjected to routine code group inspection in the schools, 184 (5.5 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 794 children, who made 1,130 attendances for examination and treatment. Squint Clinic. Number of attendances 1,161 New cases 81 Number of cases treated with orthoptic exercises and for amblyopia 95 Cured of Amblyopia 18 Discharged—Cured 21 Improved 14 Operations for squint 12 Awaiting operation 2 Under observation, attending for "tests only" 115 71 School Dental Service. Findings of Dental Inspection. The following table shows in statistical form the results of school dental inspection in the individual schools mentioned. School. Number inspected. Number referred for treatment. Number accepting treatment. Percentage of acceptances. Boys. Girls. Boys. Girls. Canterbury 519 342 370 266 495 77.8 Cann Hall 272 216 138 120 229 88.7 Capworth. 305 466 232 370 480 79.7 Church 137 374 102 295 377 94.9 Connaught 150 317 80 180 211 81.8 Da vies Lane 463 241 218 101 226 70.8 Downsell ... ... ... ... ... ... Farmer 367 197 282 151 367 84.7 Goodall ... ... ... ... ... ... Kirkdale 62 53 19 19 30 86.8 Knotts Green ... ... ... ... ... ... Lea Bridge ... ... ... ... ... ... Mayville 245 351 122 171 177 60.4 Newport 501 243 318 132 351 78.0 Norlington ... ... ... ... ... ... Sybourn ... ... ... ... ... ... St. Joseph's ... ... ... ... ... ... Tom Hood ... ... ... ... ... ... Trumpington 163 159 78 96 106 60.3 County High ... 397 ... 226 168 73.4 3,244 3,356 1,959 2,127 3,217 78.8 Report by the Authority's Senior Dental Officer (A. E. Hall, L.D.S.) During 1946, the first complete post-war year, the dental staff consisted of two dental officers and two dental attendants, which represented only two-thirds of the immediate pre-war school dental staff. Routine dental inspection was carried out in all but seven of the schools in the area; but of these seven schools, three (Lea Bridge, St. Joseph's and Knotts Green) are very small ones and do not together represent numerically one department in many of the bigger schools. The total number inspected was 7,766, which was 650 less than that of the previous year; but 525 children, who were inspected in December, 1945, at the Boys' High School, had the necessary treatment done during the year under review. 72 The acceptance of treatment rate was 78.28 per cent., an increase of 8.1 per cent. over the previous year, and 15.6 per cent. over that of 1938, the last complete pre-war year. Of those inspected, the percentage referred for treatment was 67.6 per cent.; and, of these, 82.6 per cent. received complete treatment during the year. The attendances increased by 856. While the extraction of permanent teeth showed a slight fall (37) from the previous year, the number of permanent fillings increased by over one thousand to 4,371. The number of clinic sessions devoted to inspection fell by 19, with an increase of treatment sessions by 23. The number of other operations, such as scalings, insertion of sedative dressings, root canal treatments and treatment of sensitive fractured teeth, together amounted to 305. Table IV of the Statistical Appendix, which now includes treatment of pupils attending the Boys' and Girls' Secondary Schools, gives a comprehensive idea of the work done for the school children of the area. Orthodontics. During the year 94 attendances were made by children for advice on or the adjustment of orthodontic appliances; and 76 adjustments to appliances, all of the removable type, were carried out. Thirteen impressions were taken and study models cast in connection with new cases. In addition, many children were wholly treated by extractions (permanent teeth, 72 ; temporary teeth, 241). As previously reported, the assistance of X-ray photography is indispensable for diagnosis of some cases of irregularity; and, where this was necessary, the parents were asked to take the children to either the London Hospital Dental School or Connaught Hospital for X-ray photographs to be taken. It is satisfactory to be able to record an increase in the number of parents who periodically seek advice on their children's dental 73 condition without waiting for dental disease or irregularity to show itself. With a larger dental staff it would be possible to take greater advantage of this tendency by encouraging frequent visits for examination, by bi-annual school inspections, and also by talks on the teeth. Maternity and Child Welfare. The number of mothers treated during the year 1946 increased from the previous year's figure of 109 to 172; and that of infants from 101 to 188, the mothers making a total of 440 visits and the infants a total of 286. There was a general all-round increase in the amount of work done for these patients, but at the year-end there were some 16 mothers awaiting dentures whose gums were not yet ready for the impression stage, consequently they were held over till the following year and are not able to be shown in this report. A detailed summary of the work carried out will be found in the Maternity and Child Welfare Section of the Health Report. Orthopædic Clinic. Examinations. Primary examinations 59 Re-examinations 136 Treatment. Number of children who attended for 216 Attendances made 1,793 The findings at the primary examination were Deformities—Bones and Joints. (a) Congenital— Shortening right lower limb 1 Deformity digits—foot 9 Dislocation of hip—right and left 1 74 (b) Acquired— Hammer toe 6 Hallux valgus 10 Genu varum 3 Genu valgum 2 Injury—knee 1 ,, ankle 2 Old fracture—clavicle 1 pelvis 1 Arthritis—hip 1 Hallux rigidus 2 Exostosis digits—hand 1 foot 1 Muscular. (а) Congenital— Torticollis 3 Talipes 2 (b) Acquired— Scoliosis 2 Winged scapulae 1 Pes cavus 2 Pes plano valgus 7 Valgus ankles 3 Pes varus 1 Talipes equinus—right and left 1 Contracted extensors—foot 1 Generalised Dupuytren's hand 1 Coxa valga—right and left 1 Paralysis. (a) Congenital— Spastic hemiplegia 1 (b) Acquired— Anterior Poliomyelitis 2 Pseudo hypertrophic muscular paralysis 1 Also— Kohler's disease 2 Cyst knee 1 Bursa knee 1 Ganglion foot 1 75 Admissions to Hospital. Eight children were admitted to hospital and the following operations performed— 1. Arthrodesis foot—right and left—plaster of Paris. 2. Manipulation foot—left—plaster of Paris. 3. Tendon transplantation—foot—left—plaster of Paris. 4. Tenotomy tendo achilles—right—plaster of Paris. 5. „ ,, ,, right and left—plaster of Paris. 6. Ankylosis digit 2 (hammer toe)—right and left. 7. Subcutaneous tenotomy—sterno mastoid—right. Plaster of Paris cast. 8. Subcutaneous tenotomy—sterno mastoid—left. Plaster of Paris cast. Surgical Appliances and Boots. The following have been supplied— Surgical alterations to boots 2 Minor alteration to boots and shoes 82 Repairs to surgical boot 1 Hallux valgus splints 2 pairs and one single. Artificial Sunlight Clinic. Number of children who attended 145 Attendances made 3,854 HANDICAPPED PUPILS. Statutory Medical Examinations. During the year, some 96 children were referred for statutory medical examination. As the result of examination these 96 children were classified as follows:— Behaviour Problems:— With average intelligence 10 Above „ „ 4 Below „ ,, 6 Dull and backward 17 „ „ ,, requiring re-assessment 14 Backward only 14 Educationally sub-normal requiring special education 17 Children notified as requiring institutional treatment 2 ,, reported to the Local Authority under Section 57 of the Education Act 12 96 76 Knotts Green Special School for Educationally Sub-Normal Pupils. Admitted 16 Discharged 9 Physically Handicapped Pupils. Knotts Green Open Air School. Admitted during the year 30 Discharged 23 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1946 was:— Dinners. Milk Meals. Free 1,294 10,597 For payment 5,293 Totals 6,497 10,597 Number of meals supplied:— Dinners. Milk Meals. Free 178,711 1,026,467 For payment 740,803 1,250,180 Totals 919,514 2,276,647 NUTRITION. In accordance with the regulations for routine medical inspections made under the provisions of the Education Act, 1944, the second and third code group inspections will be of children older than children previously inspected in these groups. The future records of heights and weights of children in these groups will, therefore, not be comparable with the previous records of these groups. Under the circumstances a comparison has been made of the heights and weights of the routine groups for the last four years. The following tables show in statistical form the average heights and weights (in inches and lbs. respectively) of children of the prescribed age groups during the past four years. 77 FIRST AGE GROUP. Inspected during 1943. Entrant Group Boys Girls No. Examd. Average height Average weight No. Examd. Average height Average weight Born in: 1936 94 45.27 47.84 78 46.33 48.30 1937 161 42.33 42.59 162 42.46 41.83 1938 227 41.00 40.01 180 40.54 38.48 Inspected during 1944. Entrant Group Boys Girls No. Examd. Average height Average weight No. Examd. Average height Average weight Born in: 1937 85 45.66 47.24 77 45.89 47.60 1938 233 43.46 43.16 222 43.07 42.03 1939 222 41.33 40.19 238 40.61 38.03 Inspected during 1945. Entrant Group Boys Girls No. Examd. Average height Average weight No. Examd. Average height Average weight Born in: 1938 55 44.89 46.20 62 44.67 44.45 1939 148 43.17 42.64 134 43.03 42.24 1940 130 42.42 39.83 107 40.96 38.53 Inspected during 1946. Entrant Group Boys Girls No. Examd. Average height Average weight No. Examd. Average height Average weight Born in: 1939 148 45.62 47.30 144 45.58 46.90 1940 290 43.53 43.11 273 43.17 41.90 1941 183 41.67 40.18 130 41.28 39.42 78 Observations by Dr. Mary Gilchrist. The "Entrants" group shows little change when compared with comparative records made during the war; but, when allowance is made for the normal fluctuations in the heights and weights of both boys and girls, the 1945 figures indicate that there was in that year a relatively subnormal gain in weight of seven-year old children, especially in the case of girls. Fortunately, this tendency has been checked in 1946. The impression while examining this group—that the children born in 1939 and 1940 had not done so well as children born in the later years of the war—also appears to be substantiated to some extent. In the Second and Third Age Group, the 1946 figures again show an upward trend in heights and weights. Before the war these figures' had been steadily improving. That improvement was not only checked during the war, but by 1945 the heights and weights showed a deterioration. This lost ground has now been regained in the case of both boys and girls. Rationing, and particularly bread rationing, affects the older school child almost as much as the adolescent; and it is reassuring to see that it has not had any adverse effect. School meals are Second Age Group. Second Age Group 1943 1944 1945 1946 Boys:—• No. examined 474 362 535 622 Average height 51.48 51.40 51.49 52.28 Average weight 63.71 64.38 63.52 63.07 Girls:— No. examined 414 285 430 589 Average height 51.18 51.00 51.34 52.41 Averahe weight 62.38 62.34 62.39 63.76 Third Age Group. Third Age Group 1943 1944 1945 1946 Boys:— No. examined 410 393 362 461 Average height 54.42 58.71 57.98 60.00 Average weight 87.73 90.12 88.58 95.14 Girls:— No. examined 434 366 381 453 Average height 59.31 58.93 58.20 59.80 Average weight 91.82 91.20 93.21 94.07 79 becoming increasingly popular, especially among the secondary school children, of whom 57 per cent. have school dinners as compared with 45 per cent. of the primary school children. These figures do not mean that the 43 per cent. never have school dinners. Many parents allow their children to have meals on two or three days a week, i.e. on the days when the rations for the week have been consumed. That being so, really a higher proportion than 57 per cent. have school meals during some part of each week. Since September, 1946, one-third of a pint of free milk has been obtainable by all children at school. In the Ley ton area, previous to this free issue, a high percentage of children had twothirds of a pint daily. It is not possible to say if this reduction to one-third of a pint will have any adverse effect on nutrition; but, as the percentage of children taking school dinners has been steadily increasing, any loss experienced by the children is likely to be masked by this fact. Nevertheless, many school children feel the loss of the second one-third of a pint, and it is hoped that milk production will soon allow us to restore it. CHILD GUIDANCE Since 1937 the Education Authority has had arrangements with Child Guidance Clinics—established in special departments of London hospitals or as separate organisations—for the reference thereto of children showing anti-social behaviour problems. When Walthamstow Council established a Child Guidance Clinic in 1943, arrangements were made for reference thereto of Ley ton children; and this arrangement was welcomed, as it did away with the necessity for mothers and children travelling long distances to London clinics. Owing to the great increase in the number of cases during recent years, it has become more and more difficult for Leyton cases to be dealt with at any of the clinics with which the Council has an arrangement; and during the year under review the waiting list has been so long that the arrangements are of little use. Dr. Bartlett, Educational Psychologist, Essex County Council, has been able to give valuable help in a few cases, but much more than this is required. The Education Committee has therefore submitted to the Walthamstow Committee a suggestion that a full-time educational psychologist and psychiatric social worker be appointed in the Leyton area to work under the supervision of the Walthamstow psychiatrist. 80 SPEECH THERAPY. My last Annual Report contained particulars of the transfer— in accordance with the instruction of the Ministry of Education in Administrative Memo. No. 101—of speech therapists to the school medical service. Since 1st November, 1945, the Council's two speech therapists, formerly employed as teachers, have been members of the staff of the Medical Officer of Health; and have been working in close collaboration with the school medical staff. As it has not been found possible to provide accommodation for speech therapy clinics at the health centres, it has been necessary for the speech therapists to continue their work in schools—often in unsuitable premises not conducive to the best results. The following summary shows the number of children treated and the speech defects from which they were considered to be suffering :— 1. Children under Treatment during 1946.. 122 Dyslalia 46 Stammering 59 Sigmatism 5 Lisp 5 Deafness 1 Cleft Palate 4 Hypo-rhinolalia 1 Mixed rhinolalia 1 2. Discharged 60 Stammering 15 Dyslalia 32 Lisp 7 Sigmatism 5 Hypo-rhinolalia 1 3. On Waiting List 16 4. Average Number of Cases Treated Daily 28 5. Homes Visited 160 6. Schools Visited 80 Miss Ferrada, who had been employed as a speech therapist since September, 1944, left the Council's service at the end of the year in order to take up a hospital appointment. 81 PUBLIC ELEMENTARY SCHOOLS. STATISTICAL APPENDIX. TABLE I.—Returns of Medical Inspections, a. Routine Medical Inspections. Number of Code Group Inspections:— Entrants 1,240 Second Age Group 1,191 Third Age Group 913 Total 3,344 b. Other Inspections. Number of Special Inspections 3,564 Number of Re-inspections 8,114 Total 11,678 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). I For all other Conditions Total. Percentage of children found to require Treatment. Entrants 4 265 269 21.69 Second Age Group 71 234 305 25.61 Third Age Group 55 134 189 20.70 Total (Prescribed Groups) 130 633 763 22.82 Other Routine Inspections — — — — Grand Total 130 633 763 22.82 82 TABLE II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups. No. of Children Inspected. A. (Excellent.) B. (Normal.) C. (Slightly Subnormal.) D. (Bad.) No. % No. % No. % No. % Entrants 1,240 262 21.1 764 61.6 210 16.9 4 0.3 Second Age Group 1,191 284 23.9 773 64.8 134 11.3 — - Third Age Group 913 313 34.2 539 59.0 59 6.4 2 0.2 Other Routine Inspections - - - - - - - - - Total 3,344 859 25.7 2,076 62.1 403 12.0 6 0.2 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1946. 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 2 — 2 (2) Other 13 — 13 Body 11 — 11 Scabies 60 — 60 Impetigo 55 — 55 Other skin diseases 674 - 674 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 322 322 Minor Ear Defects 428 — 428 M iscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,136 — 1,136 Total 2,701 — 2,701 83 TABLE III.—con d. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as mlnor ailments.—group I). Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Errors of refraction (including squint) Other defect or disease of the eyes (excluding those recorded in Group I) 620 — 620 119 4 123 Total 739 4 743 No. of Children for whom Spectacles were:— Under the Authority's Scheme. Otherwise. Total. (a) Prescribed 460 — 460 (b) Obtained 460 - 460 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 Hospital. (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) (1) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) 26 4 8 6 8 — 2 6 34 4 10 12 137 197 (1) Tonsils only. (2) Adenoids only. (3) Tonsils and adenoids. (4) Other lefects of the nose and throat. 84 TABLE IV. Dental Inspection and Treatment (1) Number of children who were:— (a) Inspected by the Dentist:— Aged: 3 4 160 5 504 6 665 7 790 8 782 9 669 Age Groups Total 6,600 12 657 13 586 14 334 15 47 16 23 17 9 18 1 Specials (Casuals) 1,166 Grand Total 7,766 (b) Found to require treatment 5,252 (c) Actually treated 4,341 (2) Half-days devoted to Inspection 56 Treatment 831—Total 887 (3) Attendances made by children for treatment 6,224 (4) Fillings, Permanent Teeth 4,371 Temporary ,, 609—Total 4,980 (5) Extractions, Permanent Teeth 586 Temporary ,, 5,256—Total 5,842 (6) Administrations of general anæsthetics for tions 1,699 (7) Other operations, Permanent Teeth 631 Temporary ,, 279—Total 910 85 TABLE V. Uncleanliness and Verminous Conditions. (1) Average number of cleanliness inspections per school made during the year by the School Nurses 4 (2) Total number of examinations of children in the Schools by School Nurses 21,134 (3) Number of individual children found unclean 741 (4) Number of children cleansed under arrangements made by the Local Education Authority — (5) Number of cases in which Legal proceedings were taken:— (а) Under the Education Act, 1921 — (b) Under the School Attendance Bye-laws — TABLE VI. Blind and Deaf Children. (1) 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 — — — —