AC 4411 (1) LEYTON LEY 41 Borough of Leyton HEALTH REPORT FOR THE YEAR 1947. ANDREW W. FORREST, M.A., M.D., Ch.B., D.P.H., Medical Officer of Health, School Medical Officer. 67965 1 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Mb. 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 1947. The Registrar-General's estimate of the population of Leyton during 1947 is 105,550. Other comparative population figures are:— Last official census (1931) 128,313 Last complete pre-war year (1938) 117,200 Lowest war year (1941) 84,790 First complete post-war year (1946) 101,910 The number of births registered in the Borough during 1947 was 2,359—the highest annual number registered since the year 1922, when the population was 131,600. In 1947 the birth-rate was 22.35 live births per thousand of the population; in 1922 the corresponding rate was 18.36. The last year in which the birth rate exceeded 22.35 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 33.06. In Table 5 (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 50 years. During the year under review there occurred the most widespread and serious outbreak of acute poliomyelitis, commonly known as "infantile paralysis," we have ever had in this country. Although certain of the smaller administrative areas reported no cases, the epidemic affected the whole of Great Britain. In each of five of the previous ten years no case had been notified in Leyton, and in the four years when cases were reported the average annual number of cases notified was 3.75. During 1947 some 14 cases were notified, but in two cases the diagnosis was not confirmed after admission to hospital. The number of corrected notifications was therefore 12. Of the 12 persons in whom the diagnosis was 2 firmed, five were slight and are now leading a normal life, six required more prolonged hospital treatment and have still lost the use of certain paralysed muscles, and one was fatal. Fortunately no case occurred of respiratory paralysis necessitating treatment in a special respirator (" iron lung "). One of the outstanding problems of the year has been the difficulty in recruiting the staff necessary to carry out essential services. At the end of July Dr. J. L. Rennie left the Council's service to take over the appointment of Medical Officer of Health, City of Carlisle. Dr. Hilda Menzies was promoted to the post of Deputy Medical Officer of Health rendered vacant by Dr. Rennie's resignation; and steps were taken to fill the vacancy caused by Dr. Menzies' promotion by the appointment of an Assistant Medical Officer of Health. By the end of the year, however, the vacant appointment of Assistant Medical Officer of Health had not been filled. One of this Council's pre-war permanent staff of three fulltime dental surgeons (Mr. Brash Grant) died on active service in January, 1940. Since January, 1947, Mr. J. E. Horton—who has been in the Council's service as a dental surgeon since 20th May, 1920, has been incapacitated from duty due to illness, and was subsequently superannuated on medical grounds in November, 1947. As the Council accepted, in July, 1946, the County Council's recommendations for dental staff—six dental surgeons and six dental attendants for the Borough of Leyton—it will be appreciated that it has been quite impossible to arrange for the necessary dental inspection and treatment of Leyton pre-school and school children, and of expectant and nursing mothers, with the available seriously depleted dental staff. The authorised establishment of midwives directly employed by the Council is four. Of these, one (Miss E. Roberts, S.R.N., S.C.M.) retired from the Council's service on superannuation due to ill-health on 31st January, 1947; and another, Miss M. Lynch, S.R.N., S.C.M.) was transferred to a vacant appointment as school nurse on 16th September. Although repeated advertisements were issued inviting applications for these vacant appointments, no appointment had been made to fill either of these vacancies by the end of the year. As the number of health visitors (six) is considerably below the number recommended for an area with a population of 7,000 3 children below the age of five years, the Council decided in June to appoint an additional health visitor. By the end of this year, however, no suitable application had been received for the vacancy. Mr. E. J. Steeden, Deputy Senior Sanitary Inspector, retired on reaching superannuable age at the end of December, 1946; and the vacancy was filled by the promotion of Mr. R. A. Reeves. The vacancy caused by the promotion of Mr. Reeves has not yet been filled. In November, Mr. F. W. Reeve left the Council's service to take up another appointment; but, by the end of the year, no successor had been appointed. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, 4 Extract from Vital Statistics for the year 1947. Population 105,550 Live Births:— Legitimate Males 1,215 Females 1,075 Illegitimate Males 36 Females 33 Totals 2,359 Birth Rate per 1,000 of population 22.35 Stillbirths:— Males 25 Females 17 Rate per 1,000 total (live and still) births 17.49 Deaths:— Males 624 Females 654 Totals 1,278 Death Rate per 1,000 12.10 Number of women dying from diseases and accidents of pregnancy and childbirth:— From Sepsis 1 From other causes 3 Rate per 1,000 total (live and still) births 1.66 Death rate of infants under one year of age:— All infants per 1,000 live births 33.06 Legitimate infants per 1,000 legitimate live births 33.18 Illegitimate infants per 1,000 illegitimate live births 28.98 Deaths from Cancer (all ages) 206 „ „ Measles (all ages) 2 „ „ Whooping Cough (all ages) 3 „ ,, Diarrhoea (under 2 years of age) 6 5 TABLE I. Registered Births, 1947. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 16 18 16 6 11 14 5 10 7 7 110 February 6 15 5 14 22 10 23 12 7 7 121 March 10 16 12 9 18 13 6 14 9 2 109 April 9 8 11 8 13 8 5 12 6 5 85 May 8 13 8 6 14 14 5 7 9 6 90 June 4 12 4 5 11 7 7 6 19 6 81 July 5 14 6 6 9 9 4 9 8 8 78 August 7 10 12 8 15 13 11 11 10 12 109 September 4 8 9 1 8 9 6 7 6 3 61 October 5 17 7 6 12 12 4 5 9 5 82 November 7 7 6 2 6 9 8 6 6 5 3 59 December 5 9 2 2 6 3 6 4 3 46 Transferables 105 254 105 124 275 158 72 95 81 59 1,328 Totals 191 401 203 197 420 279 162 200 180 126 2,359 6 TABLE 2. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1947. Sex. All Ages. Ages at Death in Years. In Institutions in the District Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. Not belonging to District. Belonging to District. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1. Typhoid and paratyphoid fevers M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough M 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... F 2 1 ... ... 1 ... ... ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system M 24 ... ... ... ... 3 3 3 4 7 4 ... ... ... F 17 ... ... ... ... 7 6 ... 3 1 ... ... ... ... 7. Other forms of tuberculosis M 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... F 3 ... ... 1 ... 2 ... ... ... ... ... ... ... ... 8. Syphilitic disease M 4 ... ... ... ... ... ... ... 1 1 2 ... ... ... F 2 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 9. Influenza M 5 ... ... ... ... ... ... 1 ... 1 1 2 ... ... F 5 1 ... ... ... ... ... ... ... ... 2 2 ... ... 10. Measles M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis M 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis M 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) M 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... 13. Cancer of uterus F 10 ... ... ... ... ... ... 3 3 2 1 1 ... ... 14. Cancer of stomach and duodenum M 28 ... ... ... ... ... 1 2 6 5 8 6 ... ... F 16 ... ... ... ... ... ... ... 3 6 4 3 ... ... 7 15. Cancer of breast M ... ... ... ... ... ... ... ... ... ... ... ... F 18 ... ... ... ... ... 1 1 6 6 2 2 16. Cancer of all other sites M 70 ... ... ... ... ... 1 2 7 18 32 10 F 62 ... ... ... ... ... 1 ... 9 17 16 19 17. Diabetes M 5 ... ... ... ... ... ... 1 1 ... 2 1 F 4 ... ... ... ... ... ... ... ... ... 2 2 18. Intra-cranial vascular lesions M 51 ... ... ... ... ... ... ... 2 10 16 23 F 86 1 ... ... ... ... ... 1 1 7 27 49 19. Heart disease M 176 ... ... ... ... ... ... 3 13 30 60 70 F 187 ... ... ... ... ... 4 5 6 16 44 112 20. Other diseases of circulatory system M 15 ... ... ... ... ... 1 1 1 2 8 2 F 21 ... ... ... ... ... 1 ... ... 2 5 13 21. Bronchitis M 67 3 ... ... ... ... 2 2 1 13 26 17 F 47 2 ... ... ... ... 1 4 2 6 13 19 22. Pneumonia M 35 7 ... ... ... 1 1 ... 2 10 7 7 F 24 4 ... 1 ... ... ... ... ... 1 10 8 23. Other respiratory diseases M 10 ... ... ... ... ... ... 1 ... 2 5 2 F 3 ... ... ... ... ... ... ... 1 ... 2 ... 24. Ulceration of the stomach or duodenum M 13 ... ... ... ... ... 1 1 5 2 3 1 F 4 ... ... ... ... ... 1 ... 1 2 ... ... 25. Diarrhoea (under 2 years of age) M 4 3 1 ... ... ... ... ... ... ... ... ... F 2 2 ... ... ... ... ... ... ... ... ... ... 26. Appendicitis M 2 ... ... 1 ... ... ... ... ... ... ... 1 F 2 ... ... ... ... ... ... ... 2 ... ... ... 27. Other digestive diseases M 12 ... ... ... ... ... ... ... 1 3 4 4 F 17 ... ... ... ... ... ... ... 1 7 6 3 28. Nephritis M 10 ... ... ... ... ... ... 2 2 1 3 2 F 5 ... ... ... ... ... ... 1 1 1 1 1 29. Puerperal and post-abortive sepsis. F 1 ... ... ... ... ... ... 1 ... ... ... ... 30. Other maternal causes F 3 ... ... ... ... ... 3 ... ... ... ... ... 31. Premature birth M 7 7 ... ... ... ... ... ... ... ... ... ... F 9 9 ... ... ... ... ... ... ... ... ... ... 32. Congenital malformations M 18 16 ... 1 ... 1 ... ... ... ... ... ... F 19 19 ... ... ... ... ... ... ... ... ... ... 33. Suicide M ... ... ... ... ... ... ... ... ... ... ... ... F 6 ... ... ... ... ... 1 1 2 1 1 ... 34. Road traffic accidents M 7 ... ... 1 ... ... 1 1 1 2 ... 1 F 3 ... ... ... 1 ... ... ... ... 1 1 ... 35. Other violent causes M 13 ... ... ... ... 1 ... 2 1 3 2 4 F 10 ... ... ... 1 ... ... ... 2 ... ... 7 36. All other causes M 42 2 ... ... ... 1 1 1 ... 4 9 24 F 63 ... ... 1 1 ... ... 4 3 1 9 44 Totals M 624 78 2 7 5 16 33 44 98 192 340 463 1558 441 F 654 8 TABLE 3. DEATHS IN WARDS, 1947 CAUSES OF DEATH. Leyton Lea Bridge. Central North. Central South. Forest Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. ward Not Known. 1 2 3 4 5 6 7 8 9 10 11 12 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal fever ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough 1 1 ... ... ... ... ... ... 1 ... ... 5. Diphtheria ... ... ... ... 1 ... ... ... ... ... ... 6. Tuberculosis of respiratory system 2 6 3 4 5 7 3 5 3 3 ... 7. Other forms of tuberculosis ... 1 ... ... 1 ... 1 1 ... ... ... 8. Syphilitic diseases 1 1 1 1 ... 1 ... 1 ... ... ... 9. Influenza ... 1 ... 1 ... 1 1 1 4 1 ... 10. Measles ... ... ... 1 ... ... ... ... ... 1 ... 11. Acute poliomyelitis and polioencephalitis ... 1 ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis ... ... ... 1 ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) ... 1 ... ... 1 ... ... ... ... ... ... 13. Cancer of uterus 2 ... 1 ... 1 3 ... ... 3 ... ... 14. Cancer of stomach and duodenum 5 9 3 2 12 3 4 1 1 4 ... 15. Cancer of breast ... 7 1 4 1 2 ... ... 2 1 ... 16. Cancer of all other sites 14 25 10 13 26 13 5 10 13 3 ... 17. Diabetes ... 1 ... ... 3 ... ... 1 2 2 ... 18. Intra-cranial vascular lesions 9 19 11 14 19 20 10 8 19 8 ... 19. Heart disease 33 57 17 27 58 60 26 31 36 18 ... 20. Other diseases of circulatory system 2 3 3 7 8 4 2 1 3 3 ... 21. Bronchitis 7 19 10 13 12 10 12 10 13 8 ... 22. Pneumonia 5 9 4 10 9 5 3 4 4 6 ... 23. Other respiratory diseases 2 1 2 2 ... ... ... 1 3 2 ... 24. Ulcer of stomach or duodenum 3 1 1 ... 7 1 1 ... 3 ... ... 25. Diarrhoea (under 2 years) 1 1 ... ... ... 1 1 1 ... 1 ... 26. Appendicitis 2 1 ... ... ... 1 ... ... ... ... ... 27. Other digestive diseases 2 4 ... 2 5 5 ... 4 4 3 ... 28. Nephritis 2 2 ... 1 3 3 ... 1 1 2 ... 29. Puerperal and post-abortive sepsis ... ... ... ... ... ... ... ... 1 ... ... 30. Other maternal causes ... ... ... 1 ... 1 ... ... ... 1 ... 31. Premature birth ... 4 1 ... 5 3 3 ... ... ... ... 32. Congenital malformations 1 5 3 5 8 1 6 1 5 2 ... 33. Suicide ... 2 1 1 2 ... ... ... ... ... ... 34. Road Traffic accidents ... 1 3 ... 2 1 1 2 ... ... ... 35. Other violent causes 2 6 1 1 4 4 2 ... 3 ... ... 36. All other causes 11 18 3 18 17 13 8 7 8 2 ... Totals 107 207 79 129 210 163 89 91 132 71 ... 9 10 TABLE 4. Vital Statistics of Whole District during 1947 and Previous Years. Year. BrETH8. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Inward Transferable Nett. of Nonresidents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 3 4 5 6 7 8 9 10 11 12 13 1932 1029 1666 13.10 2913 22.7 1808 236 89 53.42 1341 10.54 1933 812 1499 11.91 3070 24.4 1888 286 76 50.70 1468 11.67 1934 819 1454 11.78 2864 23.2 1774 227 64 44.02 1317 10.67 1935 777 1493 12.26 2671 21.9 1789 243 60 40.18 1225 10.06 1936 661 1421 11.85 3028 25.2 2018 262 74 52.07 1272 10.61 1937 653 1420 12.02 3190 27.0 2104 263 75 52.81 1349 11.42 1938 656 1509 12.87 2934 25.0 1938 152 70 46.38 1148 9.79 1939 605 1499 12.90 2951 26.6 1987 278 46 31.65 1242 11.21 1940 645 1353 14.02 3865 40.0 2302 335 50 39.03 1563 16.2 1941 705 1129 13.31 2430 28.6 1288 341 37 38.30 1142 13.46 1942 814 1452 16.69 2373 27.3 1546 296 73 50.27 1123 12.91 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 2617 25.6 1646 210 64 28.78 1181 11.58 1947 1328 2359 22.35 2595 24.6 1558 241 78 33.06 1278 12.10 11 TABLE 5. Birth-rate, Death-rate and Analysis of Mortality During the Year 1947. Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 Years). Total Deaths under 1 Year. Certified by Registered Medical | Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still Births. England and Wales 20.5 0.50 12.0 0.00 0.00 0.01 0.00 0.02 0.01 0.09 5.8 41 126 County Boroughs and Great Towns, including London 23.3. 0.62 13.0 0.00 0.00 0.02 0.00 0.03 0.01 0.09 8.0 47 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 22.2 0.54 11.9 0.00 0.00 0.02 0.00 0.02 0.01 0.08 3.7 36 London 22.7 0.49 12.8 0.00 0.00 0.01 0.00 0.02 0.01 0.08 4.8 37 LEYTON 22.3 0.39 12.1 0.00 0.00 0.01 0.00 0.02 0.01 0.09 2.5 33 81.61 3.28 15.10 12 TABLE 6. Comparative Statistics of Births, Mortality, Etc. LEYTON, 1898-1947. Year. Population. Births. Birth Rate. Deaths. Death Rate. Deaths under 1 year. Infantile Death Rate. 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* d112452* 2005 16.0 1414 12.6 172 85.8 1918 b125352* D112452* 1791 14.3 1723 15.3 161 89.9 1919 B129062* 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 D110800* 1499 12.90 1242 11.21 46 31.65 1940 96500 1353 14.02 1563 16.2 50 39.03 1941 84790 1129 13.31 1142 13.46 37 38.30 1942 86960 1452 16.69 1123 12.91 73 50.27 1943 87880 1595 18.14 1248 14.20 57 35.73 1944 85440 1613 18.87 1285 15.04 68 42.15 1945 87330 1474 16.87 1147 13.13 52 35.27 1946 101910 2223 21.81 1181 11.58 64 28.78 1947 105550 2359 22.35 1278 12.10 78 33.06 *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 10,002 attendances for treatment were made, representing an increase of 960 over the attendances during the previous year. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 191 1,663 1,854 Females 587 6,538 7,125 Children 154 869 1,023 Total 932 9,070 10,002 The number of persons who received free treatment was 52 (5.57 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 19 344 363 Females 33 1,495 1,528 Total 52 1,839 1,891 Defects Treated. Bursitis 74 Callosities 229 Corns, hard 133 Corns, soft 18 Corns, under nail 13 Hallux rigidus 12 Hallux valgus 37 Metatarsalgia 29 Nails, club 47 Nails, ingrowing 54 Mycotic infection 13 Pes planus 85 14 Verruca pedis 143 Hammer toe 11 Septic conditions 30 Conditions due to sprain 1 Trigger toe 3 Referred for Medical or Surgical Treatment. During the year 15 patients were referred to their own private medical practitioners or hospitals for the following conditions:— Oedema 1 Sepsis 1 Ulceration 1 Ankylosis of tarsus 1 Arthritis—Ankle 1 Excision of nail 2 Hallux Rigidus (bi-lateral) 1 Hallux valgus 1 Pes planus (spastic) 3 Sub-ungual exostosis 1 Tenotomy 1 Trigger toe (bi-lateral) 1 Scale of Charges. When the Foot Clinic was established in 1936, the Council resolved that old age pensioners and their wives, women in receipt of widows' pensions, and unemployed persons be treated free of charge. At that time, the scale of charges was 1s. 6d. for the treatment of one foot, and 2s. 6d. where treatment was required for both feet. In April, 1942, a standard charge of 2s. was made irrespective of whether one or both feet are treated. The category of persons to be treated free of charge was then restricted to unemployed persons and their dependants, old age pensioners and their wives in receipt of supplementary pensions, and women receiving widows' pensions who are also in receipt of public assistance. In March, 1942, the standard charge for treatment was increased from 2s. to 2s. 6d. On 1st January, 1947, the Foot Clinic Service was included among those services in respect of which charges are assessed under the Council's Scales of Necessity. The amount payable by the applicant for such service is 3d. for each complete 1s. of net income up to a maximum payment of 3s. 6d. 15 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 Children Adults Total Total attendances for treatment 1942 (10 mths.) — — 303 1291 1943 522 632 1154 2490 1944 328 517 845 1990 1945 302 454 756 1462 1946 261 402 663 1298 1947 91 156 247 495 Attendances during 1947. Number of patients treated 247 Children 91 Adults 156 Number of patients who had One routine treatment 247 Two „ ,, 148 Three ,, ,, 45 Four ,, ,, 5 Five ,, ,, 2 Six ,, ,, 1 Local treatment, no bath 47 495 CIVIL AMBULANCE SERVICE. The following table gives particulars of the cases transported in Council ambulances during the year:— Accidents 421 Taken ill in street 162 Maternity 597 Attempted suicide 5 Transfers to and from hospitals 1,856 3,041 The mileage covered during the year was 18,455. 16 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 acquired a sitting-case car (a 12 h.p. four-seater) for such sitting cases. PUBLIC MORTUARY. Number of bodies deposited, death being due to:— Natural causes 77 Suicide 4 Accidents 5 86 Number of Post-mortem examinations performed 86 Number of Inquests held 11 In 75 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 22 ,, occlusion-atheroma 13 Myocardial degeneration 5 Congenital aortic stenosis 1 Acute bacterial endocarditis 1 Aortic stenosis-rheumatic 2 Aneurysm left iliac artery—specific 1 Cerebral haemorrhage 3 Hypertension 8 Pneumonia 2 Suppurative bronchitis 2 Toxic goitre 1 Inhalation of birth fluids 1 Atelectasis 2 Stillborn 2 Intercranial haemorrhage due to birth tear 1 Carcinoma uterus 1 „ brain 1 ,, caecum 1 Pulmonary tuberculosis 1 Senility 4 17 Inquests. The following verdicts on Leyton residents were recorded at inquests held during the year:— Accidental 33 Suicide 6 Natural causes 1 Open verdict 1 Murder 1 SANITARY CIRCUMSTANCES OF THE AREA. SANITARY INSPECTIONS OF THE AREA. Inspections. The table below gives a summary of the Inspections made by the Sanitary Inspectors:— Number of dwelling-houses inspected 4,174 Miscellaneous inspections 828 Re-inspections 11,283 Places of entertainment 18 Schools 112 Stables 19 Urinals 78 Visits in connection with infectious diseases 439 Factories without mechanical power 30 Factories with mechanical power 262 Rag and bone dealers 5 Foster-mothers' premises 11 Hairdressers' premises 23 Public Houses 15 Offensive Trades 56 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 738 Sashcords renewed 192 Plaster repaired 1,080 Roofs repaired or renewed 999 Guttering repaired or renewed 579 18 Yards paved 51 Drains relaid or partly relaid 75 Choked drains cleared 122 New w.c. pans and traps provided 368 Sinks provided 52 W.c. cisterns repaired or renewed 258 Rain water pipes repaired or renewed 405 Vent pipes repaired or renewed 115 Sink waste pipes repaired or renewed 190 Stoves repaired or renewed 527 Coppers repaired or renewed 31 Floors repaired 535 Rooms redecorated 1,032 Windows, sills, etc., repaired 568 Cement work to sink waste gullies repaired 111 Miscellaneous defects remedied 897 Verminous Houses. Infested. Disinfested. Number of houses 203 203 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 were employed in this work, which was completed by the end of June, 1947. Premises visited 20,037 Premises reported infested 909 Premises treated:— (a) Dwelling-houses 846 (b) Business premises 63 909 Casual Complaints (not included in Special Scheme). Complaints received and investigated 303 Premises not treated (not genuine infestation) 42 Premises treated:— (a) Dwelling-houses 219 (b) Food premises 15 (c) Other business premises 27 261 Premises freed 236 19 Sewer Maintenance Treatments. All sewers in the Borough were treated in July, 1947 (followed by a further treatment in January, 1948). 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 have been kept under observation and treatment. HOUSING. Complaints. During the year 4,068 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 2,447 Statutory—Housing Acts Nil Public Health Acts 555 Notices complied with—Informal 1,745* Statutory— Housing Acts Nil Public Health Acts 280 *This figure includes notices outstanding from previous year. Housing. Number of houses erected during the year:— (a) Total (including numbers given separately under (b) ). (i) By the Local Authority— Houses 75 Flats 24 Temporary housing 258 (ii) By other Local Authorities Nil (iii) By other bodies and persons— Houses Nil Flats Nil 20 (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— Houses 75 Flats 24 Temporary housing 258 (b) For other purposes Nil (ii) By other bodies and persons Nil I.—Inspection of Dwelling-houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,174 (6) Number of inspections made for the purpose 12,111 (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 (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,447 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 1,745 III.—Action under Statutory Powers during the Year :— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil 21 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners Nil (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 555 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 280 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which demolition orders were made Nil . (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Landlord and Tenant (War Damage) Acts, 1939-1941. No applications were received from owners of houses for " Certificates of fitness." Housing Act, 1936. Information regarding 1,133 houses and 14 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 1,267 enquiries. 22 INSPECTION AND SUPERVISION OF FOOD. Inspections. The following visits were made to food premises during the year :— Slaughter-houses 29 Butchers 181 Bakehouses 79 Fishmongers 129 Milkshops and dairies 189 Provision shops 508 Dining rooms 155 Greengrocers 117 Fish friers 47 Ice cream premises 280 MILK. Dairies and Milkshops. Number of registered premises from which milk is sold 64 Premises added to register during year 1 Premises removed from register during year 2 Visits of inspection 189 Bacteriological Examinations. Designated Milk. Licenses. No. Granted. No.of Samples taken. Result. Phosphatase Reaction. Methylene Blue Test. Satisfactory. Unsat. Satisfactory. Unsat. Tuberculin Tested 13 – – – – – Accredited 2 – – – – – Pasteurised 33 7 7 — 7 — Supplementary Licences – – – – – – Tuberculin Tested 2 – — – — — Pasteurised 3 — — — — — Totals 53 7 7 – 7 — 23 ICE CREAM. Number of premises registered— As Manufacturers 34 (Of this number only 18 are actually manufacturing at the moment). For Sale or Storage 152 (Of this number only 100 are actually selling at the moment). Number of Samples taken during 1947 53 Results of Samples taken— Satisfactory 34 Unsatisfactory 19 Towards the end of 1946 your Council gave consideration to existing legislation for the control of possible outbreaks of enteric fever due to ice cream. It was felt that existing legislation did not afford the necessary control by the Council of persons engaged in the manufacture and sale of ice cream.; and, in order to safeguard the public as far as possible, your Council authorised the Medical Officer of Health to issue, on behalf of the Council, medical certificates of freedom from enteric infection to manufacturers of ice cream whose employees have voluntarily submitted themselves to medical examination. An intensive endeavour was therefore made to enlist the co-operation of all local manufacturers. All volunteers were submitted to a special medical examination, which included blood tests to ascertain freedom from typhoid and other enteric infection. Most of these tests revealed freedom from enteric infection, but weak positive results were obtained in a number of employees who had preventive inoculations against typhoid and paratyphoid fevers whilst serving in H.M. Forces during the war. In these cases the blood tests were followed by a series of urine tests, rectal swabs and further blood tests until the employee was considered to be free from danger of transmitting enteric infection. After all members of the staff of any manufacturer of ice cream had been found to satisfy these tests, the manufacturer was granted a certificate, which he could display on his premises if he wished. Of the 18 manufacturers of ice cream in the area, 14 were granted certificates. Unfortunately the Council has no power to compel the examination of employees who decline to be examined, but it is hoped that the display of certificates by those manufacturers who have obtained them may have the desired effect. 24 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1947 67 Premises registered during 1947 Nil Premises removed from Register during 1947 Nil MEAT. Slaughter - Houses.— There are six licensed slaughterhouses in the Borough, and 29 inspections of these slaughter houses were made. Meat and Foods condemned and destroyed. Household Dried Milk 152 tins Evaporated Milk 2,997 ,, Tinned Meats 610 ,, Tinned Soup 150 „ Tinned Fish 723 „ Tinned Fruit 344 „ Tinned Vegetables 951 ,, Tinned Beetroot (ex M.O.F. Depot) 30,097 ,, Sausages 182 lbs. Cheese 128 ,, Jam 771 ,, Bitter Orange Pulp 76 cwts. Grapes 48 lbs. Eggs 1,429 Sugar 280 lbs. Meat 1,138 ,, Fats 105 ,, Sweets 24 „ Pickles (ex M.O.F. Depot) 13,297 jars Fish, wet 3,649 lbs. Goat Meat and Offal 1,333 „ Poultry 526 Rabbits 274 Sheeps' Heads 159 Ox Heads 10 Offal 90 lbs. Chocolate 269 bars Flour 31 lbs. Dates 188 boxes Bacon 80 lbs. Miscellaneous Foods 1,170 packets 25 Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 6 Dairies, Milkshops and Dairymen 64 Butchers'shops, Stalls and Provision shops 378 Hairdressers'Premises 71 Fish friers 16 Offensive Trades. Rag and Bone dealers 3 Tripe boiler 1 Contagious Diseases of Animals Acts and Orders. It was found necessary to issue three notices defining " infected places " in connection with Fowl Pest outbreaks during the year. Six similar notices were issued by officers of the Ministry of Agriculture and Fisheries. 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 179. Samples analysed. Samples unsatisfactory. Aspirin 3 — Baking powder 2 — Benergy 1 — Bicarbonate of soda 1 — Black pudding 1 — Boracic ointment 1 — Bread 1 — Bun flour 1 — Butter 4 — Cabbage, pickled 1 — Catarrh tablets 1 — Chocolate 1 — Cochineal 1 — Cod Liver oil 1 — Cold and influenza mixture 1 — Colour, apple green 1 — Cooking fat 1 — Cough lozenges 1 — Crawfish 1 — Curry powder 1 — Fish paste 1 — 26  Samples analysed. Samples unsatisfactory. Flavourings 6 — Ginger, ground 1 — Ginger wine essence 1 — Gin 1 — Golden raising powder 1 — Gravy powder 1 — Glycerine, blackcurrent & honey 1 — Gripe mixture 2 — Junket powder 1 — Kidney soup 1 — Lemon squash 2 1 Margarine 3 — Meat paste 1 — Meat pie 1 — Milk 78 2 Mustard 3 — Pepper 10 4 Peppermint tablets 1 — Piccalilli 1 — Rum 1 — Sage and onion stuffing 1 — Salmon and anchovy paste 1 — Sausages and sausage meat 8 1 Spice, mixed 1 — Spinach, strained 1 — Sulphur ointment 1 — Syrup 1 — Tea 1 — Tonic yeast 1 — Vermicelli 1 — Vinegar 10 2 Vitamin malt extract 1 — Vitamin syrup 2 Vitamin tonic 1 1 Whisky 1 — Yeast extract 1 — Yeast tablets 1 — Zinc ointment 1 — 179 13 27 Legal Proceedings. Food and Drugs Act, 1938. Pepper, adulterated with flour. Fined £5 or two guineas costs. FACTORIES. THE FACTORIES ACT, 1937. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power 262 21 – Factories without mechanical power 30 4 – Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) – – – Total 292 25 — 2. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) Lack of cleanliness 2 2 — Sanitary Conveniences :— Insufficient 5 3 1 Unsuitable or defective 16 15 — Other Offences — — — Total 23 20 1 OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937.) Nature of Work. Instances. Notices served. Prosecutions (1) (2) (3) (4) Nil Nil Nil — 28 MATERNITY AND CHILD WELFARE. CHILD WELFARE. Notification of Births.— Two thousand three hundred and seventy-three notifications of births were received during the year. By medical practitioners 431 By midwives 1,966 Child Welfare Centres. On the following page will be found a Table giving detailed information regarding the attendances of infants and children at the Council's child welfare clinics during the last three years. It will be seen that during that time the total annual attendances at both Health Centres have increased from 13,575 in 1945 to 22,565 in 1947—an increase of 66 per cent. Health Visitors. During the year the Health Visitors have made 14,673 visits to homes, as follows :— (a) To expectant mothers :— First visits 39 Total visits 39 (b) To children under 1 year of age :— First visits 2,430 Total visits 9,006 (c) To children between the ages of 1 and 5 years :— Total visits 5,628 29 TABLE 7. ATTENDANCES, EXAMINATIONS, etc., 1945—1947. Leyton Green Park House All Centres 1945 1946 1947 1945 1946 1947 1945 1946 1947 Under 1 year— 1st attendances 532 826 896 607 682 877 1139 1508 1773 Subsequent attendances 4612 6885 8967 4554 5930 8332 9166 12815 17299 Total attendances 5144 7711 9863 5161 6612 9209 10305 14323 19072 1-5 years— 1st attendances 88 76 82 82 75 78 170 151 160 Subsequent attendances 1519 1587 1552 1581 1854 1781 3100 3441 3333 Total attendances 1607 1663 1634 1663 1929 1859 3270 3592 3493 Total attendances, both age groups 6751 9374 11497 6824 8541 11068 13575 17915 22565 Average attendance per session 63.87 62.79 76.64 64.36 57.32 73.78 64.12 59.71 75.21 Number examined by clinic doctor 2090 2237 3029 2164 2201 3092 4254 4438 6121 Number weighed 6702 9368 11493 6842 8539 11065 13544 17907 22558 30 Dental Treatment. Expeotant Mothers. Children Patients treated 199 153 Attendances 339 295 Extractions 368 240 Fillings 152 218 Other dental operations 97 55 Advice only 17 14 Scalings 92 — Anaesthetics— General 79 93 Local 117 17 Dentures supplied— Full upper and lower 12 Full upper 4 Full upper and partial lower 2 Partial upper 8 26 Orthopaedic Treatment. Primary Examinations.— During the year 54 children were referred from the Child Welfare Clinics to the Council's Orthopaedic Surgeon. Re-examinations.—In addition to the 54 new cases mentioned above, 43 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—One hundred and two children made 803 attendances for special treatment by the Council's Physiotherapist. Provision of Surgical Appliances.—Fifty-three children had minor alterations to boots and shoes and two children were supplied with walking calipers, one with the addition of a varus T-strap. Anterior Poliomyelitis. Of the three pre-school children who have been attending the orthopaedic clinic for after care, two have been discharged as cured. 31 Special Eye Clinic. The Council's Ophthalmic Surgeon had referred by the Clinic Medical Officers 116 pre-school children, who made 153 attendances for examination and treatment. Artificial Sunlight Treatment. Number of cases treated 86 Total number of attendances 984 Convalescent Home Treatment. Children. Five 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 6 mothers and their babies to have periods of convalescence following confinement. Ophthalmia Neonatorum. No. of Casea Notified. Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hosp. 8 — 8 8 — — — Infant and Foetal Mortality. The following figures show the infantile, neo-natal and stillbirths mortality rates during the last five years. Year. Live Births. Deaths under Mortality Rate. Stillbirths. No. Rate per 1000 (live and still) Births. 1 year. 4 weeks. Infantile. Neo natal. 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 1947 2,359 78 45 33.06 19.07 42 17.49 32 TABLE a Infantile Mortality, Year 1947—Ages. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Smallpox ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... 1 ... ... ... 1 Diphtheria and croup ... ... ... ... ... ... ... 1 ... 1 Influenza ... ... ... 1 1 ... ... ... ... 1 Tuberculous meningitis ... ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... 1 ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 3 2 ... 5 Pneumonia (all forms) 1 1 ... ... 2 3 2 3 1 11 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 3 2 ... 5 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 3 1 ... ... 4 ... ... ... ... 4 Atelectasis 2 i ... ... 3 ... ... ... 1 4 Congenital malformations 11 3 ... ... 14 2 1 ... 2 19 Premature birth 11 3 ... ... 14 2 ... ... ... 16 Atrophy, debility and marasmus 1 ... 1 ... 2 1 ... ... ... 3 Other causes 4 1 ... ... 5 ... ... 2 ... 7 Totals 33 0 1 1 45 9 9 11 4 78 Nett Births registered during the calendar year Legitimate 2,290 Illegitimate 69 Nett Deaths registered during the calendar year Legitimate infants 76 Illegitimate infants 2 33 Public Health Act, 1936. Child Life Protection. On 1st January, 8 foster mothers and 8 children—and at the end of the year 9 foster mothers and 9 children—were subject to inspection. The Council's Child Protection Visitors made 66 visits of inspection during the year. Sommary, Yeas 1947. Number of nurse children on Register, 1st January 8 Number of nurse children notified by foster mothers during the year 5 Nurse children removed:— To parents or relatives 1 Adopted 1 To institutions 1 To another foster mother 1 Number of nurse children on Register on 31st December 9 MATERNAL WELFARE. Ante-Natal Clinics— Attendances.— First Subsequent Attendances. Attendances. Total. 585 1,088 1,673 The average number in attendance at the Ante-Natal Clinics held at the Council's two Centres during 1947 was 12.12 per session. The number of home visits made by Health Visitors to expectant mothers during the year was 39. Maternity Beds. One thousand and thirty-two patients were admitted during 1947 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. Eight inspections were made to these institutions during the year. 34 Puerperal Pyrexia. Seventeen cases of puerperal pyrexia were notified during the year. The causes of pyrexia were considered to be :— Urinary infection 5 Pleurisy 1 Mastitis 1 Infected haematoma of womb 1 Puerperal sepsis 2 Not known 7 17 Obstetric Consultant. The advice of the Council's Consultant Obstetrician was not sought during the year. Maternity Mortality. There were 4 maternal deaths of Leyton residents during the year. Medical Aid. In accordance with the Rules of the Central Midwives' Board a midwife must notify the Local Supervising Authority forthwith, on every occasion on which she sends for medical aid. Three hundred and twenty-three such notifications were received. Fees paid to Doctors. Two hundred and ninety-three accounts were received from general medical practitioners for assistance rendered to midwives under the provisions of the Medical Practitioners (Fees) Regulations, 1940. The total amount paid to medical practitioners during the year was £451 10s. 6d. 35 Post-Natal and Gynaecological Clinic. Leyton Green Health Centre. Number of Sessions 19 Letters of Invitation 322 First Attendances 214 Re-attendances 133 During the year 19 sessions of the Post-Natal and Gynaecological Clinic were held. The number of new patients who attended was 214, out of 322 who received appointments to attend (= 66 per cent.). Of these, 172 were post-natal (i.e., they had had confinements within the previous three months); and 42 were gynaecological. The disposal of these cases was as follows :— Discharged after one attendance 108 Re-attended for examination and treatment 106 The total number of attendances was 347. The average attendance per session was 18.26—with a maximum of 24 and a minimum of 8. Free medical prescriptions were issued in 97 cases at a total cost of £29 15s. 6d.; and 26 prescriptions were issued for payment by the patients. The following are the main conditions which have been found on examination :—- Subinvolution of the uterus 17 Cystocele and rectocele 8 Retroversion of uterus 23 Anaemia 2 Defective perineum 1 Cervical erosion 4 Vaginitis 4 Sterility 1 Fibroid 4 Birth control 40 Inflamed adnexa 1 Ovarian cyst 3 Pregnancy 2 Prolapsed uterus 1 36 Record of Cases attended by Council Midwives, 1947. 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 279 636 915 (b) As Maternity Nurses 37 94 131 Ante-natal Visits 721 2,478 3,199 Ante-natal Examinations 2,250 5,002 7,252 Post-natal Visits 5,772 15,137 20,909 Administrations of Gas and Air Analgesia 20 181 201 MATERNAL MORTALITY AND THE ANTE-NATAL CLINIC. (Report by Dr. Hilda Menzies.) The year 1947 marks the end of an era in Maternity and Child Welfare. For the last thirty years local authorities have been encouraged to appoint medical officers responsible for both antenatal clinics and child welfare clinics. The National Health Service Act, 1946, which comes into operation in July, 1948, discourages such appointments, and the separation of ante-natal work from child welfare is envisaged. The obstetrician has been advocating this for a number of years and in 1935, before the maternal mortality rate began to fall, Holland(l) after describing why the measures to deal with maternal mortality had been ineffective, stated that until the necessary personnel had been trained there was not the slightest chance of lowering the rate. " The lowering of maternal mortality will not be difficult once the proper personnel, with the requisite training centres have come into being and a new obstetric tradition has arisen— as in such circumstances it surely will. The great mistake that the central and local authorities of this country have made is in believing that the creation of an efficient obstetric service 37 was merely an administrative problem. One need only recall the mistaken attitude towards ante-natal work which, prosecuted by an improvised personnel, has almost assuredly done more harm than good by leading to unnecessary interference with normal cases." When the Royal College of Obstetricians and Gynaecologists issued their Report in 1945 on a National Maternity Service, the maternal mortality rate had approximately halved in ten years ; but the writers of the report considered that the improvement had been associated much more with advances in general medicine than with any improvement in obstetric practice. This, if correct, disproved Holland's prophecy of ten years earlier. The damning criticism in this Report of ante-natal clinics maintained by local authorities may be fairly considered to have influenced the pronouncements in the National Health Service Act, 1946, on this subject. What the immediate effect on the Service will be after July 5th, 1948, is not clear—possibly none—but it is at any rate plain that those Maternity and Child Welfare Officers who, like myself, have been doing this work the past 20—30 years, will continue to do ante-natal clinics only on sufferance until we are replaced by something brighter and better. It would seem, therefore, a good time to do a little stocktaking. Leyton is one of the extra metropolitan municipal boroughs which come within the Greater London area. It is largely an artisan neighbourhood with surprisingly good mortality rates. Thomas (1946) in a description of Croydon's obstetric services compared the maternal mortality, still birth rate and neo-natal death rates for six years in Croydon with the rates for England and Wales. In Table 1 I have shown these averages and added the Leyton figures for the same years :— TABLE 1. Average Maternal Mortality, Stillbirth and Neo-natal death rates for the years 1938-1943 for England and Wales, Croydon and Leyton. Maternal Mortality Av. (1938-1943) Stillbirth rate Av. (1938-1943) Neo-natal death rate Av. (1938-1943) England and Wales 2.43 34.9 26.6 Croydon 1.69 28.5 20.0 Leyton 1.73 27.3 23.6 38 I have been in charge of the ante-natal clinics in Leyton for the last twenty years and have supervised the work of the domiciliary midwives for most of that time. I am therefore interested to find whether there has been a disproportionate mortality among the women for whose ante-natal supervision I have been partly or wholly responsible. TABLE 2. Year Total Births (live) Births in Hospitals Births in E.M.H. Births booked by G.Ps. at home Births in private Mater. nity Homes Births booked by Midwives (no Dr.) No. in attendance at Municipal Ante-natal Clinics 1936 1,421 673 — 151 107 490 430 1937 1,420 689 — 156 140 435 465 1938 1,509 782 — 168 134 425 550 1939 1,499 760 60 108 168 403 499 1940 1,353 490 190 97 56 520 423 1941 1,129 351 344 51 30 353 477 1942 1,452 526 274 71 77 504 647 1943 1,595 468 321 85 142 579 580 1944 1,613 568 370 71 115 489 514 1945 1,474 624 267 68 80 435 544 1946 2,223 1,042 91 116 127 847 801 1947 2,359 1,212 — 129 116 902 585 Total 19,047 8,185 1,917 1,271 1,292 6,382 6,515 Table 2 gives the registered live births for the years 1936-1947 (inclusive). It shows the place of birth and the number who received ante-natal supervision at the municipal ante-natal clinics. Over these twelve years the proportion attending the clinics was one-third of the births. The increase of the births in one year by 50 per cent. in 1946 put a great strain on all the services concerned with the care of mothers and children. The domiciliary births were nearly doubled in one year, while there was an increase of over 400 in the hospital births and of 250 in the number of mothers attending the municipal ante-natal clinics. The sudden drop in the chinic attendances in 1947 while the total births in the area increased by 136, was due to the co-operation of a neighbouring voluntary hospital. This hospital very kindly put twelve beds per month at my disposal in addition to the cases they booked directly. I was therefore able to refer to this hospital another 144 women who, for one reason or another, required hospital confinement, and they received their ante-natal supervision at the hospital instead of through my chinic. 39 It is expected that the majority of women attending a municipal ante-natal chnic will be women who have booked a midwife for domiciliary confinement, and no conclusions can be drawn about the expected mortality of any group of pregnant women without first considering whether they are a selected group. Routine supervision at the Leyton municipal clinics is given to women who are being admitted to one of three hospitals with which Leyton Borough Council has an arrangement for maternity cases. These women are booked and supervised at the municipal clinic until the hospital takes over their supervision at about the 32nd week, when a report is sent to the hospital from the clinic. Among the chnic attendances are also women who are anxious to remain at home and may actually have booked with a midwife, but whose general health or obstetric history makes hospital confinement advisable. They form a difficult group as sufficient emphasis must be put on the possible dangers to induce them to change their minds without lessening their chances by frightening them. Finally there are the women who have not made any arrangement at all for confinement, who may appear at the clinic at about the eighth month, have almost certainly no accommodation at home and who expect a hospital bed to be waiting for them. Before the war the hospital cases comprised about one-quarter of the women who received ante-natal supervision at the municipal clinics. Since the war (i.e., for eight years out of the twelve under review) the proportion has risen to one-third. Thus the cases under supervision at the municipal clinic are, on the whole, not an average sample of pregnant women in the area. They contain an undue proportion of first pregnancies [thus in 1944, 284 were primiparae and 228 were multipara (Menzies 1945) ]. Of the multipara, those who book a midwife but who are not considered suitable for domiciliary confinement and others who are doubtful for home delivery will have attended the clinic, plus the careless ones whose failure to arrange for confinement may or may not have included failure to obtain nutritional priorities during pregnancy. How they compare as obstetric risks with the Leyton women who have booked directly at hospital and received all their supervision at the hospital it is impossible to say without knowing what proportion of the hospital beds are booked on the "first come first served" principle, and what proportion is left to be filled from the consulting obstetricians' clinics. The cases booked by general practitioners for domiciliary confinement or by private maternity homes ought to come nearest to the midwives' 40 cases in expected normality, as when a general practitioner considers a woman unsuitable for delivery either at home or in a nursing home he refers her either to the municipal clinic or direct to hospital. It is of course possible that a general practitioner occasionally books a case against his better judgment when the woman refuses to go to hospital, but in the relatively small proportion (viz., 6 per cent.) of women who book a doctor for home confinement, and the smaller proportion who book a doctor for nursing home delivery it is reasonable to assume that the patient is accustomed to accept that doctor's advice. Maternal Deaths.—Out of 38 total maternal deaths in the twelve years, 7 followed abortion and 1 was due to a ruptured ectopic gestation. These had no ante-natal supervision and deaths from abortion are not likely to be directly influenced by maternity and child welfare services, although it is encouraging to note that 5 out of the 7 deaths occurred in the first six years under review, and only 2 in the second half of the period. There were therefore 30 deaths of women who had ante-natal supervision from some source, the causes of death being :— Toxaemia 7 Haemorrhage 6 Shock 5 Infection 6 Cesarean Section 4 Heart Disease 2 30 Of the 6,515 women who had been under supervision at the municipal ante-natal clinics there were 7 deaths—a mortality of 1.07 per thousand. Four of these were emergency admissions to hospital (2 toxaemias, 1 shock with retained placenta, and one puerperal septicaemia). The other three had been admitted to hospital during pregnancy on account of their unsatisfactory general condition—one a decompensated mitral stenosis, the second an elderly primipara who was referred to hospital at 34 weeks as a toxæmia and who subsequently died of parametritis following Cæsarean section at 39 weeks, and the third a multipara of 41 years who was referred to hospital at 32—34 weeks because of unsatisfactory general condition. She was admitted to hospital three weeks 41 before labour and had a normal labour but became unconscious two days later and died twenty-six days after labour from pulmonary embolism due to pelvic and femoral phlebo-thrombosis. TABLE 3. Cause of Death Ante-natal Supervision given by Hospital or E.M.H. (10,102 births) General Practitioner or private Maternity Home (2,563 births) Municipal Clinic (6,515) Midwife (6,382) Toxaemia 2 3 2 (1) Haemorrhage 2 2 0 2 Shock 3 1 1 (1) Infection 1 ( + 1) 3 2 (1) Cæsarean Section 3 (+1) 1 Heart Disease 1 ( + 1) 0 1 Total ... 12 (+3) 9 7 2 (+3) Table 3 shows the distribution of deaths according to the place of ante-natal supervision, and the births to which they refer is given in each column. No death appears in the column of hospital deaths if the woman was admitted as an emergency ; only the booked hospital cases are listed in this column. The three which are shown in brackets in the hospital column are the three which are mentioned in the previous paragraph as having been referred to hospital from the municipal chinic during pregnancy. There were two deaths from hæmorrhage in apparently normal multiparæ in midwives' cases. The three shown in brackets in this column are included in the chinic column. Reference to Table 2 shows that some 1,917 births took place in reception areas during the war. In Table 3 I have classified these with the hospital births, as the emergency maternity homes were often run in connection with hospitals, and actually two of the hospital deaths occurred in the provinces. Similarly I have grouped births booked by general practitioners at home with births in private maternity homes as, although not all the private maternity home cases book a doctor, five out of the seven nursing home deaths in this series happened to be of women who had a doctor in charge of the confinement. This is the only column where the number of deaths (9) is out of proportion to the births dealt with (2,563) and it is greater than is likely to be due to chance. This may be of some importance as, along with the disappearance of the municipal ante-natal clinic as such, there is to 42 be a suggested increase in the ante-natal work of the general practitioner. Moreover, a leading article in The Lancet of May 15th states :— " The obstetricians and the general practitioners have not resolved their difference of opinion whether, inside the public maternity service, midwifery should be concentrated into the hands of those practitioners whose aptitude and experience most certainly entitle them to undertake this work ; and the establishment of local obstetric committees, which it was hoped might prove fair and not unfriendly arbiters, has so far been resisted. Clearly, a smooth inauguration of the generalpractice and maternity services would not be easy without the guidance of these statutory Committees." It is at least satisfactory to find that there has not been a disproportionate mortality in the women who have attended the municipal ante-natal clinics in the last twelve years. Considerable emphasis has been laid at the clinics on the normahty of childbearing, and there is insistence at all the local authority clinics— ante-natal, child welfare and school—on the importance of good nutrition. In 1935 in Leyton we were already supplying milk, cod liver oil and iron to expectant mothers who were considered to be in need of extra nourishment, and in that year a proposal was put to the Ministry of Health to supply in addition eggs, fresh fruit and vegetables by means of vouchers. At the time this scheme was not sanctioned by the Ministry of Health but it is interesting to find that a similar scheme is now in operation for all expectant mothers. An obstetrician who apparently considers some good work has been done by the local authority clinics has recently stated in an article on ante-natal care :— " The recent war was a testing time and served to show on what solid foundations the maternity and child welfare service has been built. It was the Government's nutrition policy—including a system of food priorities—that maintained and improved the health of mothers and children."—(Nixon). In the same article Professor Nixon states that in ante-natal work in the past much harm has been done by emphasising the abnormal, that the ante-natal chnic ought to be used for spreading the gospel of positive health, but that the chance is often missed. Whether the concentration of ante-natal work in the hands of hospital officers and general practitioners will lessen the emphasis on the abnormal for the average healthy woman, and prevent 43 the incidence of dangerous abnormalities in the few, has still to be proved. The present Maternity and Child Welfare services are now to be spht on this unproved assumption. Holland, E. (1935), Medical Officer, April 13th (145). Menzies, H. (1945), Medical Officer, July 21 st (21). Nixon, W. C. W. (1948), Health Educational Journal, April (71). Thomas, R. C. (1946), Lancet, January 19th (101). THE CARE OF PREMATURE INFANTS. My Annual Report for the year 1945 contained details regarding arrangements for the special care of premature infants, along with an analysis of cases which occurred during that year. As the information was not included in my last Annual Report, I submit hereunder in tabular form the necessary information regarding premature births during the years 1946 and 1947. It will be seen that, of 4,554 births during these two years, 258 were premature (i.e., 5.66 per cent.). Of these 258 premature children, 150 were born in hospitals and 108 at home. There are still no special facilities in local hospitals for the nursing of small premature babies born at home. NOTIFIED BIRTHS—PREMATURE BIRTHS. Year 1946 1947 Total notified Births 2,157 2,397 Premature Births At home In Hospital in Borough In Hospitals, etc., outside Borough Total At home In Hospital in Borough In Hospitals, etc., outside Borough Total Born 48 2 63 113 60 1 84 145 Died— 1st 24 hours 7 2 8 17 4 1 5 10 1—7 days 2 — 3 5 5 — 3 8 8—28 days 3 — 3 6 — — 3 3 44 DOMESTIC HELP SCHEME. My Annual Report for the year 1946 contained a historical summary of the facilities for the provision of home helps which have been in existence since 1931, and of the action which was taken by your Council to provide a more comprehensive scheme for the provision of domestic help in accordance with the suggestions contained in Ministry of Health Circular 179/44. On 1st August, 1946, the new scheme—of supplying domestic help to persons sick and infirm in addition to maternity cases— was put into operation ; and on that date a special Domestic and Home Help Office was opened at 267, High Road, Leyton. Despite advertisements in local papers, apphcation to the local office of the Ministry of Labour, and the circularising of members of the Women's Voluntary Service by the Local Organiser, it has been a difficult task to recruit and maintain a sufficient staff of domestic helps to provide for all applicants for the service. At the end of 1946 three full-time and ten part-time workers were on the staff. During 1947 two of the full-time staff resigned, and many part-time home helps were put on probation for varying periods. At the end of the year there were one full-time and 18 part-time home helps. It was found during the year that the Home Help Office at 267, High Road, Leyton, which was established in premises used by the Women's Voluntary Service, was inconvenient; and in December your Council decided to transfer the Office and Staff to the Public Health Department in the Town Hall, where all records regarding the Maternity and Child Welfare Services are kept. The number of completed cases during 1947 was 238. At the end of the year 15 apphcants were receiving help, and 56 further applications had been received. Of the 238 cases, 211 were for assistance during confinement, the average period of help being two weeks. The remaining 27 cases varied considerably in length ; the average being 5.4 weeks. The total cost in home helps' wages for the cases completed in 1947 was £2,448, of which £677 was recovered from the apphcants. 45 Disability. No. of cases. Average number of weeks help supplied. Heart disease 4 5 Asthma and bronchitis 3 2½ High blood pressure 2 1½ After operation 2 10 Varicose veins 2 2 Rheumatoid arthritis 1 12 Ulcers of leg 1 11 Thrombosis 1 27 Epilepsy 1 8 Debility after tonsilitis 1 3 Migrain 1 5 Cancer 1 3 Septic hand 1 1 Spinal disease 1 2 Erythema nodosum 1 2 Injury to leg 1 2 Temporary blindness 1 3 Nervous debility 2 6½ DAY NURSERIES. My Annual Report for 1946 contained somewhat full observations on the general question of nursery provision for children under five years of age ; along with a special report dealing with such matters as periods of attendance of children who had been withdrawn, nursery dietories, progress of children and other matters. Scale of Charges.—In March your Council reviewed the amount of contributions to be made by parents and decided that the scale of charges in future should be in accordance with the Council's scale of necessity, the minimum charge to be Is. per day and the maximum charge 5s. per day. Outbreak of Sonne Dysentery, Ellingham Road Nursery.—On 10th July one member of the nursing staff and two 46 children were found to be suffering from diarrhoea, and bacteriological examination of rectal swabs showed that the infection was Sonne Dysentery. Thereupon all children and members of the staff were swabbed, and eight further children were found to be carriers of Sonne Dysentery. All positive reactors were excluded, and were not allowed to return until after three successive swabs proved to be negative. Two children were found to be carriers of Sonne Dysentery ; and excluded until they were proved to be free from risk of infection. Attendances.—The following table shows the average daily attendance at the Council's two Day Nurseries during 1947. TABLE No. 9. WAR-TIME DAY NURSERIES—AVERAGE DAILY ATTENDANCE, 1947 Month Knotts Green Nursery Ellingham Road Nursery Under 2 years Over 2 years Average total attendances Mon. to Fri. Under 2 years Over 2 years Average total attendances Mon. to Fri. January 6.95 35.17 42.12 7.69 33.00 40.69 February 6.30 33.15 39.45 8.15 35.25 43.40 March 7.95 37.47 45.42 7.33 37.52 44.85 April 8.20 35.25 43.45 6.00 28.95 34.95 May 9.57 38.47 48.04 4.19 26.33 30.52 June 10.47 35.28 45.75 6.61 32.76 39.37 July 11.26 33.00 44.26 4.69 29.34 34.03 August 10.80 29.70 40.50 6.50 26.60 33.10 September 11.59 35.86 47.45 10.86 31.90 42.76 October 12.30 34.52 46.82 11.17 34.43 45.60 November 10.10 35.55 45.65 12.55 32.40 44.95 December 7.28 35.47 42.75 11.28 31.14 42.42 Average for Year 9.38 34.90 44.35 8.80 31.63 39.72 47 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Table showing the number of notified cases of infectious diseases and their disposal. Disease Notifications received Removed to Total removed to Hospitals Chingford Sanatorium Other Hospitals Smallpox ... ... ... ... Diphtheria 9 7 2 9 Erysipelas 34 ... 2 2 Scarlet Fever 221 93 1 94 Pemphigus Neonatorum 5 ... ... ... Pulmonary Tubercolosis 89 ... 69 69 Tuberculosis, other forms 9 ... 8 8 Pneumonia Ophthalmia 192 1 121 122 Neonatorum 8 ... 8 8 Typhoid Fever ... ... ... ... Paratyphoid Fever 3 3 ... 3 Puerperal Pyrexia 20 ... 20 20 Cerebrospinal Meningitis 4 1 2 3 Poliomyelitis 13 12 ... 12 Polioencephalitis 1 ... 1 1 Encephalitis Lethargica ... ... ... ... Dysentery 2 2 ... 2 Measles 698 26 1 27 Whooping Cough 178 11 ... 11 Malaria ... ... ... ... Totals 1,486 156 235 391 ACUTE POLIOMYELITIS. Acute Poliomyelitis is a notifiable infectious disease of the central nervous system. It has long been known under the popular term of " infantile paralysis "—a misleading name ; for the disease may occur in adults, and paralysis does not always occur. Although it is compulsorily notifiable, its incidence is to a great extent conjectural, as it is very difficult (in the majority of cases impossible) to recognise until paralysis occurs. The cases actually notified therefore represent only the persons suffering from recognisable paralysis, and not the number of persons notified. There is no disease which has given rise to so many dogmatic statements subsequently proved to be false, and it is generally 48 admitted that the more we learn of poliomyelitis the less appears to be our real knowledge of it. In the past it has had a well marked seasonal prevalence in the autumn; but the occurrence of cases in June, 1947, gave rise to uneasiness, inasmuch as it indicated the possibility of a widespread outbreak as the year advanced. That possibility was confirmed by the unprecedented and widespread outbreak throughout the country during the summer and autumn months. Administrative Measures. On 26th July there was addressed to all local medical practitioners a special communication containing information regarding the special features of the outbreak and the facilities available ; and on that date steps were taken to postpone local arrangements for surgical removal of tonsils and adenoids in Leyton children until such time as the prevalence of poliomyelitis might show signs of receding. At the same time, in collaboration with your Baths Superintendent, special precautions were taken to ensure that the residual chlorine in swimming pools was kept at a constantly high level, and that all hired bathing suits and towels were adequately sterilised. It was not considered to be necessary to take any special measures with regard to the closure of schools, day nurseries, cinemas or swimming pools. Cases Notiifed in Leyton 1938-1947 (inclusive). The following list shows the annual number of cases of acute poliomyelitis, notified in this Borough during the last ten years :— 1938 — 4 1943 — 0 1939 — 3 1944 — 0 1940 — 0 1945 — 0 1941 — 0 1946 — 3 1942 — 5 1947 — 14 Cases Notified during 1947. On page 50 I submit the relevant information, in tabular form, regarding the cases of acute poliomyelitis notified during this year. Disposal of Cases. All cases were admitted at once to the fever hospital, where they were seen regularly by the Council's Consulting Orthopaedic Surgeon. 49 After the acute stage had subsided it was necessary to arrange for the transfer of four of these cases to orthopaedic hospitals for special treatment. Incidence. Of the 14 persons notified to be suffering from poliomyelitis during the year, in two cases the diagnosis was not confirmed as the result of observation in hospital. The " corrected " notifications—12 cases in a population of 105,550 persons—therefore represent an attack rate of 10.13 per 100,000 population ; which compares with an attack rate of 18 per 100,000 population for England and Wales. Sex and Age Distribution. Of the 12 cases, seven were males, and five were females. The age distribution was :— Under one year 1 case One to five years 2 cases Five to fifteen years 6 cases Fifteen to twenty-five years 2 cases Over 25 years 1 case It will be seen that at least one case occurred in each of the five age groups ; and, although the incidence was greatest among children of school age (5 to 15 years), at no school in the area did more than one case occur. Mortality and Morbidity. One patient, a male aged 33 years, died in hospital nine days after notification. Of the 12 cases in which the diagnosis was confirmed, five were sufficiently slight not to require long-stay in-patient treatment in hospital and not likely to interfere with a normal life, six were of moderate severity requiring longer hospital treatment but with a, good prospect of an ultimate return to a normal life, and one was of fatal severity. Fortunately no case occurred of paralysis of respiratory muscles, necessitating treatment in a special respirator (" Iron Lung "). 50 BOROUGH OF LEYTON. Summary of Notified Cases of Acute Poliomyelitis and Polio-Encephalitis, 1947. No. Date of Notification. Sex. Age. Site of Initial Paralysis or Paresis. Condition at end of year. 1 25.3.47 M 13 Both arms, trunk and both thighs. Greatly improved. Abdominal muscles still weak. At school. 2 12.7.47 M 10 Weakness both legs. Diagnosis not confirmed. Quite recovered. At school. 3 20.7.47 F 17 Paralysis left leg. Much improved. Still wearing leg splint. At work. 4 24.7.47 M 6 mths. Paralysis left leg. Much improved. Slight weakness muscles left foot. 5 28.7.47 M 7 Paresis left leg. Complete recovery. At school. 6 16.8.47 F 3 Paralysis right upper arm. Still in hospital. Paralysed. 7 23.8.47 F 5 Paralysis soft palate. Complete recovery. 8 27.8.47 F 24 Paresis both arms and both legs. Diagnosis not confirmed. At work. 9 29.8.47 M 13 Paresis palate and both legs. Much improved. Removed from district. 10 11.9.47 F 27 Paralysis left arm and hand. Still in hospital wearing splint. 11 17.9.47 F 5 Paralysis left leg. Completely recovered. 12 17.9.47 M 33 Paralysis of head and trunk muscles. Died on 26.9.47. 13 3.10.47 M 1y. 4m. Paresis left leg. Much improved. 14 14.8.47 M 11 Paralysis right lower leg. Improving very slowly. Wearing splint. 51 SMALLPOX. During the year no case of smallpox occurred in the area. Vaccinal State of Children examined at Routine Medical Inspection. During the year under review vaccination was still compulsory. 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 1942 3,010 539 17.9 1943 2,909 789 27.1 1944 2,688 691 25.7 1945 2,401 624 26.0 1946 3,344 988 29.5 1947 3,667 1,285 35.1 Total 18,019 4,916 27.2 SCARLET FEVER. Year. Cases Notified. Deaths. Case Fatality per cent. 1943 386 0 0.00 1944 110 0 0.00 1945 312 0 0.00 1946 201 0 0.00 1947 221 0 0.00 DIPHTHERIA. Year. Cases Notified. Deaths. Case Fatality per cent. 1943 28 1 3.57 1944 24 1 4.16 1945 43 2 4.6 1946 38 1 2.6 1947 9 1 11.1 52 ARTIFICIAL IMMUNISATION AGAINST DIPHTHERIA. Immunisation by Private Medical Practitioners. Number of private medical practitioners who applied for supplies of toxoid-antitoxin 15 Number of children immunised 44 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 1947. Age 0-5 years. Age 5-15 years. Total. 1. Number of children who completed the course of immunisation during the year 1,391 154 1,545 2. (a) Approximate estimated child population at end of year 8,950 11,730 (b) Percentage of child population considered to be immunised at end of year 49.4 72.6 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. Percentage of School Children Immunised. Entrants Second Age Group Third Age Group No. Exmd. No. Immunised % No. Exmd. No. Immunised % No. Exmd. No. Immunised 0/ /o 1944 1,282 922 71.9 647 513 79.0 759 470 61.9 1945 693 487 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 1947 2,465 1,866 75.7 994 834 83.9 208 121 58.1 53 Incidence of Diphtheria Among Protected Persons. During 1947 two 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 Diagnosis. T=Throat. N=Nose. E=Ear. 4 M 27.9.44 2.1.47 T— Tonsillitis 15 M 1941 8.8.47 T+ Scarlet Fever TUBERCULOSIS. Notifications.—Ninety-eight patients were notified for the first time in 1947 as suffering from tuberculosis. The number was made up as follows :— Males. Females. Total. Pulmonary Tuberculosis 50 39 89 Non-Pulmonary Tuberculosis 4 5 9 54 44 98 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1947 :— Pulmonary. Non-Pulmonary. total M. F. Total. M. F. Total. Number on Register at commencement of year 296 187 483 22 39 61 544 Number first notified during the year 50 39 89 4 5 9 98 Number of cases entered in Register otherwise than by Notification 11 11 22 ... 1 1 23 Number removed from the Register during the year 46 34 80 7 4 11 91 Number remaining at the end of the year 311 203 514 19 41 60 574 Details of cases removed from the Register during the year Died 27 20 47 2 2 4 51 Removed from the district 14 9 23 1 2 3 26 De-notified 5 5 10 4 ... 4 14 54 Deaths.—Forty-one deaths from tuberculosis were recorded. The following table gives particulars regarding the new cases which have occurred during the year :— Age Periods. New Cases. Pulmonary. Non-Pulmonary. M. F. M. F. 0 - - - - 1 2 1 - 2 5 1 1 2 1 10 — - 1 - 15 5 7 — - 20 4 8 — 1 25 16 14 1 1 35 7 2 - - 45 5 3 — — 55 4 2 — — 65 and upwards 6 1 - - Totals 50 39 4 5 Institutional Treatment. During 1947 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 32 30 1 3 66 Children 5 2 2 2 11 55 TABLE No. 10. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1947. 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 9 2 ... 1 2 ... ... ... 2 1 1 ... ... Erysipelas 34 ... ... ... ... ... ... ... ... 3 8 17 6 Scarlet Fever 221 2 3 8 20 23 125 29 4 3 4 ... ... Pemphigus Neon. 5 5 ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 89 ... ... 2 ... 1 2 ... 12 41 10 14 7 T.B. Others 9 ... ... ... 1 1 3 1 ... 3 ... ... ... Pneumonia 192 15 2 7 3 5 21 6 6 18 26 43 40 Ophthalmia Neon. 8 8 ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 3 ... ... ... ... ... ... 1 ... ... ... 2 ... Puerperal Pyrexia 20 ... ... ... ... ... ... ... ... 19 1 ... ... Cerebrospinal Meningitis 4 2 ... 1 ... ... ... ... ... ... ... 1 ... Poliomyelitis 13 1 1 ... 1 ... 3 3 1 3 ... ... ... Polioencephalitis 1 ... ... ... ... ... ... 1 ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 2 ... ... ... ... ... ... ... ... ... ... 1 1 Measles 698 43 77 80 97 137 254 6 2 2 ... ... ... Whooping Cough 178 26 32 30 29 18 42 ... ... ... 1 ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1486 104 115 129 153 185 450 47 27 93 51 78 54 56 TABLE 11. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1947. DISEASE. Total. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 9 3 ... ... ... 2 ... ... ... 1 3 9 Erysipelas 34 4 11 4 4 2 4 1 1 3 ... 2 Scarlet Fever 221 14 28 16 24 43 13 15 41 12 15 94 Pemphigus Neon. 5 ... 1 2 ... 1 ... 1 ... ... ... ... Pulmonary T.B. 89 11 11 7 16 12 5 8 8 6 5 ... T.B. Others 9 1 ... ... ... 2 1 2 2 1 ... ... Pneumonia 192 15 33 23 24 45 11 10 11 12 8 122 Ophthalmia Neon. 8 ... 3 2 1 1 1 ... ... ... ... 8 Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 3 ... 1 1 ... 1 ... ... ... ... ... 3 Puerperal Pyrexia 20 1 4 ... 2 8 1 2 1 1 ... 20 Cerebrospinal Meningitis 4 ... 2 1 1 ... ... ... ... ... ... 3 Poliomyelitis 13 1 1 ... 1 3 1 2 2 1 1 12 Polioencephalitis 1 ... ... ... ... 1 ... ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 2 ... 1 ... ... ... ... ... ... 1 ... 2 Measles 698 30 62 50 60 89 143 102 68 49 45 27 Whooping Cough 178 20 40 11 10 32 21 19 9 10 6 11 Malaria ... ... ... ... ... ... ... ... ... ... ... ... Totals 1486 100 198 117 143 242 201 162 143 97 83 314 57 SCHOOL MEDICAL SERVICE. The figures set out below relate to the calendar year ended 1947. Number Roll Average Attendance Percentage of Attendance 1. Secondary Schools 14 3,526 3,185 90.33 2. Primary Schools 28 7,720 6,685 86.59 Totals 42 11,246 9,870 87.76 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 2,465 Second Age Group 994 Third Age Group 208 Total 3,667 Of 3,667 children who were examined in the code age-groups, 3,224 (or over 87 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 3,901 comparing with 3,564 during the previous year. Re-inspections. The number of re-inspections during 1947 was 9,456. 58 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 2,465 468 18.9 Second Age Group 994 238 23.9 Third Age Group 208 33 15.8 Total (Code Groups) 3,667 739 20.1 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 985 children were found to be unclean out of a total number of 26,160 examined (i.e., 3.9 per cent.) Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 2,006 33 9 Capworth Street 2,028 67 12 Cann Hall Road 1,604 27 17 Church Road 1,570 55 3 Connaught Road 2,125 33 5 Downsell Road 1,733 50 32 Davies Lane 1,990 60 20 Farmer Road 1,462 33 3 Goodall Road 1,195 29 15 Kirkdale Road 349 6 2 Lea Bridge Road 186 — — Mayville Road 2,013 231 47 Norlington Road 1,472 18 10 Newport Road 2,193 42 24 Sybourn Street 2,429 28 5 St. Joseph's 385 10 4 Trumpington Road 1,129 27 10 Knotts Green and Cobbold 291 17 1 Leyton County High School — — — Total 26,160 766 219 Number of individual children found unclean 985 of whom 219 were referred to the Minor Ailments Clinics. 59 The incidence of uncleanliness for the past 10 years is shown in the following table. Year Number of Examinations Number Cautioned Number Excluded 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 1947 26,160 766 219 195,714 8,049 1,884 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 3,265 children attended the clinics, and 14,218 attendances were registered. Defective Vision—Of the 3,667 children subjected to routine code group inspection in the schools, 176 (4.8 per cent.) were found to be suffering from some eye defect requiring treatment. Special Eye Clinic.— During the year there were referred to the Ophthalmic Surgeon 857 children. They made 1,093 attendances for examination and treatment. Squint Clinic. No. of new cases 137 Total number of attendances 1,047 No. of cases treated for squint 63 Cured 30 Improved 20 Still under treatment 13 No. of cases treated for amblyopia 33 Cured 20 Improved 5 Still under treatment 8 No. of patients cured by operation 12 No. of patients attended for " tests only " 192 60 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 ... ... ... ... ... ... Cann Hall 281 267 101 124 190 84.4 Capworth ... ... ... ... ... ... Church ... ... ... ... ... ... Connaught 172 390 67 187 191 75.1 Davies Lane ... ... ... ... ... ... Downsell 323 284 284 251 402 75.1 Farmer ... ... ... ... ... ... Goodall 282 229 110 87 140 71.0 Kirkdale 49 57 15 16 28 90.3 Knotts Green ... ... ... ... ... ... Lea Bridge ... ... ... ... ... ... Mayville ... ... ... ... ... ... Newport ... ... ... ... ... ... Norlington 229 441 107 239 256 73.9 Sybourn 410 213 352 171 351 67.1 St. Joseph's 40 32 23 20 30 69.7 Tom Hood ... ... ... ... ... ... Trumpington ... ... ... ... ... ... County High 497 416 262 211 372 78.7 Report by the Authority's Senior Dental Officer (A. E. Hall, L.D.S.) Administration . The year 1947 has been one of considerable difficulty in the carrying out of the necessary dental treatment for mothers, infants and school children in the area due to the very depleted dental staff. On 18th January a dental attendant was appointed in a permanent capacity to replace one who had acted in a temporary capacity during part of the war, and to work with Mr. Horton at the Council's Health Centre at Leyton Green. On the day she commenced duty, however, Mr. Horton was admitted to hospital with an illness from which he did not recover sufficiently to resume his duties, and was lost to the Council's Health Service. It was 61 found possible to engage a part-time dental officer for eight sessions per week at Leyton Green Health Centre, and on 4th February a private medical practitioner was engaged to give gas anaesthetics on two sessions per week in the Health Centres, thus freeing the dental officers for two extra conservative sessions per week, and giving the equivalent of one and ten-elevenths dental officers in the area. One of the disadvantages of employing part-time private dental practitioners is that they are only able to devote certain sessions to the work, and it has been found necessary, therefore, to enlist the assistance of no less than four practitioners during the year, thus losing some of the continuity and personal contact between practitioner and patient which is always so desirable. By this means one has been able to keep the Dental Centre at Leyton Green open ten-elevenths of its time and to maintain one and ten-elevenths dental officers in the area. Under a comprehensive dental service, as envisaged by the Education Act of 1944, to give complete annual inspection and treatment to all children in the area who may require it up to the increased leaving age of 15 years, and to carry out the recommendations of the Interdepartmental Committee on Dentistry as regards all the priority classes (i.e., expectant and nursing mothers, pre-school children, school children and adolescents) the Staff for the area should be at least five full-time dental officers and five full-time dental attendants for the school population of approximately 11,600 children, and the equivalent of two full-time dental officers and two full-time dental attendants for the work to be done under the Maternity and Child Welfare Service. In July, 1946, the Education Authority provided for an establishment of five full-time dental officers until the school leaving age was raised, this number then to be increased to six ; but this programme of expansion has been delayed due to war damage repairs to the Health Centres, the lack of suitable additional premises as Health Centres and to the inability to secure the services of sufficient dental officers of experience to staff the scheme. On 4th October the dental surgery at Park House was closed and temporarily removed to the medical inspection room at Connaught School while the necessary war damage repairs were carried out, and it was so evacuated until the end of the period under review in this report. When these repairs are completed and Park House is re-opened there will be two fully equipped dental surgeries on those premises with the possibility of accommodating a third dental officer as a temporary measure. 62 Much of this development will depend upon the necessary numbers of dental officers being obtainable, but at the present time they are not coming forward in sufficient numbers adequately to staff the public dental services as the majority of newly qualified men and those released by the Army appear to wish to establish themselves in private practice before the advent of the new Health Service in July, 1948. Routine Treatment of School Children. Figures showing the amount of work carried out for these children will be found in Table 4, page 74. Interesting points to note in connection with them are :— 1. That the ratio of permanent fillings to extractions is 5.6 : 1. 2. That attendances for treatment average 1.5 per child treated. 3. That the number of children inspected in a session at school averages 150. It will be seen that the number of children actually treated is slightly greater than the number found to require treatment. This is due to treatment carried out for children who had been inspected in December of the previous year. The percentage acceptance rate (76.39 per cent.) compares favourably with the last published rate for the whole country (67.8 per cent.). Orthodontics. There is a growing demand for, and appreciation of, this work by parents and children. In any understaffed dental scheme it is essential to see that too many orthodontic cases are not undertaken to the detriment of the routine conservation of children's permanent teeth. Bearing this fact in mind, as many as possible were treated along modern lines as taught in the Children's Department of the teaching hospitals at the present time. The Authority's Senior Dental Officer attended a Post-Graduate Course on the subject at Guy's Hospital Dental School during the year under review. 63 Analysis of Orthodontic Cases, 1947. Impressions taken 205 (48 cases) Study models cast 205 (48 cases) Orthodontic appliances fitted 71 Space retainers 11 Alterations and repairs 6 Attendances 425 Advice 149 Cases sent for X-ray 2 In addition to the above, 147 permanent teeth and 496 temporary teeth were extracted for orthodontic reasons. Dentures for School Children. Due to extensive fractures of upper incisor teeth in accidents, it was necessary to supply partial upper dentures to two children. Day Nurseries. All children above two years of age were inspected at the two day nurseries during the year, and the necessary treatment carried out where accepted. Number inspected 81 Number referred for treatment 18 Percentage acceptance rate 88.8 per cent. Maternity and Child Welfare. All mothers, expectant mothers and pre-school children referred to the Council's dental officer at Park House Health Clinic were advised and treated during the year. It is satisfactory to note that many mothers are to-day much more ready to seek early advice on their children's dental condition ; but unfortunately many of the mothers themselves, while anxious to have an aching tooth removed, are not so ready to accept complete conservative treatment by filling, inlay or crowning together with any necessary gum treatment (which in some cases may require four or five visits) and the supply of partial dentures to render them dentally fit. A summary of the work carried out for these patients will be found in the Maternity and Child Welfare section of the Health Report. To Summarise. Although a considerable amount of work has been done during the year, there remains much more which could be done by increasing the dental staff and the number of treatment centres ; and thus inspecting the children at more frequent intervals—at the 64 very least annually, and preferably twice a year. By lectures, films and tooth-brushing classes in Infants' Departments, it should be possible to stimulate the children's interest in the aim and object of the school dental service as laid down years ago by the former Board of Education : " That all children shall leave school in a sound dental condition, trained in the care of the teeth and without the loss of permanent teeth." Orthopaedic Clinic. Miss A. E. Findley, who had been in the Council's service as Masseuse and later as Physiotherapist since 1927, retired on superannuation in May, 1947. Miss M.E.A. Harris took over the duties of Physiotherapist when Miss Findlay retired. Examinations. Primary examinations 62 Re-examinations 188 Treatment. Number of children who attended for 245 Attendances made 1,841 The findings at the primary examination were :— Deformities—Bones and Joints. (a) Congenital— Deformity digits—hands and feet 7 Dislocation of hip 2 (b) Acquired— Internal derangement of knee 2 Hallux valgus 12 Genu valgum 7 Hallux rigidus 2 Muscular. (a) Congenital— Torticollis 3 Talipes calcaneo-valgus 3 Spengels shoulder 1 (b) Acquired— Scoliosis 11 Winged scapulae kyphosis 5 Pes cavus kyphoscoliosis 3 Pes piano valgus 2 Pes planus 49 65 Admissions to Hospital. Six children were admitted to hospital and the following operations performed— 1. Bursa inner side knee joint. 2. Removal of glass from inner side left malleolus. 3. Arthrodesis 1st interphalangeal joint 5th digit of left hand. 4. Transplantation of tibialis anticus tendon. 5. Median Stoffel left arm. 6. Investigation left knee joint. As the result of examination these 90 children were classified as follows:— Deaf 1 Delicate 54 Educationally sub-normal 19 Epileptic 2 Maladjusted 6 Physically handicapped 3 Unfit for education within the school system 5 90 Surgical Appliances and Boots. Minor alterations to shoes (wedges, etc.) 101 Surgical alteration to shoes 3 Repairs to surgical caliper 1 Elbow splint 1 Artificial Sunlight Clinic. Number of children who attended 178 Attendances made 1,691 Anterior Poliomyelitis. Seven school children, who contracted anterior poliomyelitis during the outbreak of 1947, attended the orthopaedic clinic for observation and after care following their discharge from hospital. Four of these children had been discharged as cured before the end of the year, and three are making satisfactory progress. HANDICAPPED PUPILS. Medical Examinations. During the year, some 90 children were referred for special medical examination. 66 In addition to the above, 79 children were examined because of difficulties at home or school, and were ascertained as set out below : Behaviour problems 24 Dull and backward 36 Backward only 19 79 Several of these children are being referred to the Child Guidance Clinic for appropriate treatment. Special School for Educationally Sub-Normal Pupils. Admitted 18 Discharged 6 Physically Handicapped Pupils. Knotts Green Open Air School. Admitted during the year 32 Discharged 27 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1947 was :— Dinners. Milk Meals. Free 1,560 11,159 For payment 7,901 — Totals 9,461 11,159 Number of meals supplied :— Dinners. Milk Meals. Free 214,037 1,957,064 For payment 1,033,159 Totals 1,297,196 1,957,064 67 CHILD GUIDANCE (Report by Dr. Mary L. Gilchrist.) From 1st September, 1947, an Educational Psychologist was appointed by Essex County Council to work at the Walthamstow Child Guidance Clinic and deal specially with children in the Borough of Leyton and the Forest Division of the County. This appointment should be of great value to the schools and scholars of the Borough. For years it has been pointed out in these Annual Reports that many children presented for statutory medical examination because of educational failure were shown to have average or above-average intelligence. In spite of that knowledge it has rarely been possible to apply the necessary remedy, and the children have had to struggle on as best they could. These school failures were not always due to emotional or environmental factors, but to some educational difficulty ; and it is this group who should benefit specially from the help and advice of the educational psychologist. For two years now we have been greatly handicapped in helping cases who required child guidance, as the special clinics attached to London Hospitals, to which cases had been referred previously, are now too busy with their own district cases. After a great deal of delay, Essex County Council have appointed an additional psychiatrist and psychiatric social worker ; and Leyton children are now beginning to have the skilled psychiatric attention they require. The fruits of this work are, unfortunately, very slow in maturing ; and it will be some time before positive results can be expected. It may be that we are now much more aware than we used to be of " problem children," and therefore look for cases which at one time we should not have considered as problems at all ; it may be the upheaval of war and the underlying anxieties of modern urban life have " thrown up " the unstable child as well as the unstable adult. Certainly the number of difficult children and difficult home situations appear to be greatly in excess of the number of fifteen years ago. The assessment and treatment of these children add greatly to the work at school clinics and ancillary services. SPEECH THERAPY. In January, 1947, one of the Council's two speech therapists left to take up another appointment; and, as the vacancy was not 68 filled, only one speech therapist has been undertaking the work since that time. In consequence of such radical reduction in staff, two alternatives were open :— (1) To cut down the number of children attending and thereby continue to give each child the same amount of treatment as he had received when there were two speech therapists practising; or (2) To cut down the length of treatment each child received per week, taking suitable stammerers of a similar age and the same sex in small groups. The second alternative was adopted, as it seemed preferable that a comparatively large number of children should receive treatment—though their rate of progress would be slightly slower— rather than that a smaller number received treatment, resulting in a very long waiting list. (It is emphasised that some defects tend to become intensified where treatment is deferred). The following figures show the number of cases dealt with in 1947 as compared with the previous year :— Children under treatment at the end of December, 1946 122 Children under treatment at the end of December, 1947 101 Children discharged during 1946 60 Children discharged during 1947 42 Student assistants from the West End Hospital for Nervous Diseases have been attending two days per week during May, June and July ; and three days per week during the months September to December, 1947. The new clinic premises at the High Road Baths became available on April 21st. They comprise two rooms and are a great improvement on the unsuitable premises in schools previously available. In October it was no longer possible for the speech therapist to have the accommodation previously available in Goodall Infants' School, and it then became necessary to transfer to the new clinic at High Road Baths the children who had been attending Goodall School. In view of the greater distances of certain schools from the clinic premises, in cases where the parents could not accompany the children arrangements have been made for them to be accompanied by school helpers or speech therapy students. 69 The following summary shows the number of children treated and the speech defects from which they were considered to be suffering :— Children at present Undergoing Treatment— Diagnosis of Defects— Boys Girls Total Stammering 39 10 49 Dyslalia 24 13 37 Sigmatism 4 2 6 Lisp 2 — 2 Deafness 1 — 1 Cleft palate 1 1 2 Dysphonia 1 — 1 Mixed rhinolalia 1 — 1 Hyper-rhinolalia — 1 1 Hysterical mutism 1 — 1 74 27 101 Incidence of speech defects among seniors, juniors and infants— Seniors Juniors Infants Total Stammering 13 22 14 49 Dyslalia — 11 26 37 Lisp — — 2 2 Sigmatism 1 4 1 6 Others 1 3 3 7 15 40 46 101 Discharged—42. Seniors Juniors Infants Total Dyslalia — 7 15 22 Stammering 6 4 2 12 Sigmatism — 2 — 2 Lisp — 1 2 3 Cleft palate 1 — — 1 Retarded speech — 2 — 2 7 16 19 42 70 3. On Waiting List 23 4. Average Number of Cases Treated Daily 25 5. Homes Visited 157 6. Schools Visited 53 7. Children referred to other Clinics :— To the Psychiatrist 3 To the Psychologist 2 For further medical advice 4 For hospital consultation 2 For dental treatment 1 12 STATISTICAL APPENDIX. TABLE I. Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. a. Periodic Medical Inspections. Number of Inspections in the prescribed Groups Entrants 2,465 Second Age Group 994 Third Age Group 208 Total 3,667 b. Other Inspections. Number of Special Inspections 3,901 Number of Re-inspections 9,456 Total 13,357 71 C. Pupils Found to Require Treatment. Number of individual children found at Periodic Medical Inspection to require treatment (excluding dental diseases and infestation with vermin). Group. For Defective Vision (excluding Squint). For all other Conditions Total individual Pupils Percentage of children found to require Treatment. Entrants 7 461 468 18.9 Second Age Group 57 181 238 23.9 Third Age Group 17 16 33 15.8 Total (Prescribed Groups) 81 658 739 20.1 Other Routine Inspections — — — — Grand Total 81 658 739 20.1 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1947. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin 24 4 628 ... Eyes—(a) Vision 81 7 108 3 (b) Squint 58 12 20 ... (c) Other 37 1 399 ... Ears—(a) Hearing 9 16 22 ... (b) Otitis Media 28 30 140 ... (c) Other 9 16 281 1 Nose or Throat 140 186 524 4 Speech 13 17 29 ... Cervical Glands 20 30 83 ... Heart and Circulation 4 12 17 ... Lungs 55 68 156 ... Developmental—(a) Hernia 4 7 4 ... (b) Other 1 12 11 ... Orthopaedic—(a) Posture 7 2 13 ... (b) Flat Foot 69 11 41 ... (c) Other 146 45 66 ... Nervous System—(a) Epilepsy 4 8 ... (b) Other 13 13 65 ... Psychological—(a) Development 5 3 13 ... (b) Stability 3 8 59 ... Other 120 32 3332 ... 72 TABLE II. B. Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Age Groups. No. of Pupils Inspected. A. Good. B. Fair. C. Poor. No. % No. % No. % Entrants 2465 1685 68.3 746 30.2 34 1.4 Second Age Group 994 825 83.0 155 15.6 14 1.4 Third Age Group 208 187 89.9 21 10.1 — — Other Routine Inspections — — — — — — — Total 3667 2697 73.6 922 25.1 48 1.4 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1947. 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. Skin— Ringworm— Scalp—(I) X-ray treatment (2) Other 10 Body 11 Scabies 16 Impetigo 28 Other skin diseases 561 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 397 Minor Ear Defects 336 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1531 Total 2890 73 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated A3 mlnor ailments.—group I). Defect or Disease. Number of Defects dealt with. Errors of refraction (including squint) 595 Other defect or disease of the eyes (excluding those recorded in Group I) 136 Total 731 No. of Pupils for whom Spectacles were— (a) Prescribed 520 (b) Obtained 520 Group III.—Treatment of Defects of Nose and Throat. Total number treated. Received operative treatment:— (a) for adenoids and chronic tonsillitis 79 (b) for other nose and throat conditions 16 Received other forms of treatment 103 198 Group IV.—Orthopedic and Postural Defects. (a) No. treated as in-patients in hospitals or hospital schools 7 (b) No. treated otherwise, e.g., in clinics or patient departments 523 Group V.—Child Guidance Treatment and Speech Therapy. No. of pupils treated— (a) Under Child Guidance arrangements Nil (b) Under Speech Therapy arrangements 101 74 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils who were :— (a) Inspected by the Dentist:— Age Groups Aged : Total 4,612 3 ... 4 109 5 314 6 349 7 407 8 417 9 484 10 469 11 500 12 488 13 445 14 311 15 171 16 97 17 35 18 16 Specials (Casuals) 1,568 Grand Total 6,180 (b) Found to require treatment 4,195 (c) Actually treated 4,506 (2) Half-days devoted to Inspection 34 Treatment 845—Total 879 (3) Attendances made by children for treatment 6,991 (4) Fillings, Permanent Teeth 3,311 Temporary „ 1,160—Total 4,471 (5) Extractions, Permanent Teeth 584 Temporary ,, 4,121—Total 4,705 (6) Administrations of general anaesthetics for extractions i,580 (7) Other operations, Permanent Teeth 1,075 Temporary „ 409—Total 1,484 75 TABLE V. Infestation with Vermin. (1) Total number of examinations in the Schools by School Nurses 26,160 (2) Number of individual pupils found to be infested 985 (3) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2) Education Act, 1944.) — (4) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3) Education Act, 1944.) —