Ac 4411 (1) Leyton ley 42 Borough of Leyton. HEALTH REPORT FOR THE YEAR 1948. ANDREW W. FORREST, m.a., m.d., ch.b., d.p.h., Medical Officer of Health. 1 CONTENTS. pages 1. Opening Remarks 3—9 2. Vital Statistics 12—23 3. Infectious Diseases 26—32 4. General (a) Food Poisoning 34—36 (b) Scabies 36 (c) Mortuary 37 5. Sanitary Circumstances of the Area 40—53 6. National Health Service Act, 1946, Part III 56—96 (a) Sec. 21 Health Centres 62—65 (b) „ 22 Care of Mothers and Young Children 66—67 (c) „ 23 Midwifery 78—79 (d) „ 24 Health Visiting 79 (e) ,, 25 Home Nursing 80 (/) ,, 26 Vaccination and Immunisation 81—86 (g) „ 27 Ambulance Service 86 (h) ,, 28 Prevention of Illness and After Care 87—90 (i) „ 29 Domestic Help 90—96 7. School Medical Service 98—114 3 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Me. 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 1948. VITAL STATISTICS. Population. The last official census—that of the year 1931—showed the population of the Borough of Leyton to be 128,313 persons. The Registrar-General's estimate of the present population of the Borough is 106,100 persons, showing a gradual but progressive increase during the post-war years from 101,910 in 1946 to 106,100 in 1948. Disregarding the abnormal figures of the two world-war periods, the present population of Leyton now approximates to what it was some 43 years ago. Prom the year 1905, when it was 105,000, the population gradually increased until it reached its maximum figure (133,500) in 1924, since when there has been a gradual fall to the present-day figure of 106,100. Births. There has been a sharp fall in the number of births registered, and in the birth rate per thousand of the population, during 1948. From the following figures of the last five years, of First two were war years, it appears that the sudden Increase in births reached its maximum in 1947. Year. Births. Birth Rate. 1944 1,613 18.87 1945 1,474 16.87 1946 2,223 21.81 1947 2,359 22.35 1948 1,810 17.06 Deaths. Deaths of Leyton residents certified during the year numbered 1,118, giving a death rate of 10.53 per thousand of the population; and this is the lowest general death rate recorded since 1938. With the progressive increase in the expectation of life which has been taking place during this and the last generation, coupled with the great fall in the birth rate during the same period there has occurred a fundamental change in the age constitution of the population. The proportion of old people in the population has been increasing progressively at the expense of the young; and it redounds to the credit of the health and social services that there 4 has been no corresponding increase, but rather a fall, in the general death rate. During 1948 the number of deaths of infants under one year of age was 38, the infantile mortality rate being 20.99 per thousand registered live births—by far the lowest rate ever recorded since official figures became available. It was in the year 1918 that the first Maternity and Child Welfare Committee came into being in Leyton. Now that the Committee has ceased to function as such, the following figures are submitted as a tribute to their efforts in the saving of infant life during the thirty years of the Committee's existence, and as an example to be emulated by their successors. Some idea of the actual saving of infant lives may be obtained from the fact that the 'infantile mortality rate 'represents the number of deaths of infants under one year of age per thousand births. Year. Births. Deaths under One Year of Age. Infantile Mortality Rate. 1918 1928 1938 1948 1,791 1,853 1,509 1,810 161 91 70 38 89.9 49.1 46.3 20.9 These are impressive figures showing, in one small but important part of the municipal health service, what can be achieved by organised effort on the part of a Welfare Authority conversant with local needs and determined to ensure that such needs are met. In consequence of the greater attention which has been devoted by Leyton Council during recent years to the care and welfare of the mothers of illegitimate children, it is significant that the death rate of illegitimate infants is now less than that of the legitimate. For the first time since official statistics have been available there has not been a single death of an illegitimate infant under one year in Leyton. There was a time, not so very long ago, when the death rate among illegitimate infants was notoriously high; and these figures give some indication of the beneficent change in the survival rate of illegitimate infants which has been brought about in Leyton in the short period of ten years. Year. Death Rate of Infants under One Year. Legitimate. Illegitimate. 1938 1948 43.56 21.57 150.00 Nil 5 During the year under review three women died from disease and accidents associated with pregnancy and childbirth. Of these, one could not be considered to be normally resident in Leyton. She came from Scotland, and died as the result of a septic abortion; but her death in Leyton increases the Leyton maternal mortality rate by one-third.. The vital statistics to which reference has been made above are merely extracts considered to merit special attention. Additional statistical information will be found in the body of the Report (pages 12—23). INFECTIOUS DISEASES. During the previous year (1947) there occurred the most widespread and serious outbreak of acute poliomyelitis, commonly known as "infantile paralysis we have ever had in this country. In that year 14 Leyton cases were notified, of which one was fatal. Fortunately there was no recurrence of the epidemic in 1948, when only two cases were notified. One of the outstanding epidemiological features of the year 1948 was the high incidence of both measles and whooping cough —two of the most dangerous infectious diseases in young children. Among the 1,088 children notified to be suffering from measles, there was not a single death. This compares very favourably with the last pre-war year when measles was epidemic—the year 1937, when there were notified some 1,556 cases, of whom 23 died. It is clear that the type of measles in 1948 was much milder than before the war. Unfortunately there is no comparable reduction to report in the mortality from whooping cough. Of 623 notified cases of whooping cough, three died during the year. Whooping cough is one of the most serious of the infectious diseases affecting children, and over a thousand deaths per annum are attributable to it. In addition, it leaves a serious aftermath of debilitating illness in later life. More than half the deaths from whooping cough occur in children under one year of age; the mortality is even higher in children under six months; and few children survive an attack of whooping cough contracted under the age of three months. Clearly the prevention of whooping cough is one of the most important and urgent problems in preventive medicine. During recent years many whooping cough vaccines, prepared in America and in this country, have been put on the market; and many applications have been received from parents who wished their children to be protected. 6 Unfortunately many of these vaccines have had discouraging results when tried out on susceptible children. It would be unfortunate if parents were denied a reliable means of protection against such a serious infection as whooping cough; but it would also be unfortunate if the Local Health Authority's medical services were brought into disrepute by the administration of a form of immunisation whose value is still uncertain. Under the circumstances attention is drawn to the report on pages 83 to 86 outlining the special controlled investigation into the efficacy of whooping cough vaccines which is being carried out in Leyton by the Local Health Authority in collaboration with the Medical Research Council. Scarlet fever incidence was relatively low, and it remained of the mild type to which we have become accustomed during the last decade. One of the most encouraging features in the epidemiologic field was the position with regard to diphtheria. During 1948 only five cases were notified, and there was not a death from diphtheria during the year. This is a welcome and encouraging turn in the tide of a disease which was at one time one of the chief causes of death and lifelong disability. In the year 1935 Leyton Corporation inaugurated a municipal clinic for the immunisation of children against diphtheria, and the work has gone on steadily ever since. The significance of the effect of such mass protection may be appreciated by comparing the following figures of diphtheria incidence and mortality in Leyton in 1948 with those of the last year before municipal facilities for immunisation were available in the Borough. Year. Notified Cases. Deaths. Case Fatality. 1934 1948 257 5 11 Nil 4.28 per cent. Nil No case of smallpox occurred in the area. Under the provisions of the National Health Service Act, 1946 the Vaccination Acts were repealed; and on 5th July, 1948 vaccination ceased to be compulsory. Routine medical inspections in schools show that only 35.7 per cent. of Leyton school children are now protected against smallpox by vaccination. From the statistical table on page 30 it will be seen that during 1938 there was a significant increase in the incidence of and mortality from tuberculosis, both pulmonary and nonpulmonary. To what extent this increase in tuberculosis may be 7 attributable to general nutrition, to housing conditions, or to the shortage of beds in sanatoria it would be premature to hazard a definite opinion; but there can be no doubt that tuberculosis infection is spread by persons suffering from the disease in an active form, and that such persons in the home are a constant source of danger to all members of the household. For that reason every effort should be made either to increase the accommodation available in sanatoria or hospitals, or to provide alternative housing accommodation or portable outdoor huts for infectious cases for whom institutional treatment is not available. The excellent results of the French "Grancher System" whereby infants and young children are removed at once from infectious tuberculous parents, justify urgent consideration being given to the need for increasing —under the provisions of the Children Act, 1948—the boarding-out accommodation available for young children from tuberculousinfected households. NATIONAL HEALTH SERVICE ACT, 1946. On "the appointed day" (5th July, 1948) there came into being the above Act—the greatest and most comprehensive scheme of public medical provision ever to be put into operation in any country. Under the provisions of that Act all residents in Great Britain (as well as temporary residents from abroad) of whatever age or income level, are entitled to free medical attention and treatment either at home or in hospital. Some idea of the comprehensive medical and ancillary services available may be obtained by reference to page 57. Under the provisions of this Act the Leyton Welfare Authority, and the Maternity and Child Welfare Committee, ceased to function as such on 4th July, 1948; and on the following day the County Council became responsible for the administration and control of all services outlined in Part III of the Act, i.e., midwifery, maternity and child welfare, health visiting, home nursing, a priority dental service for expectant and nursing mothers and children, domestic help when needed on health grounds, vaccination and immunisation against infectious diseases, additional special care and after-care in cases of illness, ambulance services, blood transfusion and laboratory services. Previously Essex County Council had decided to decentralise the administration of all services included in Part III of the Act to Leyton Health Area Sub-Committee and their officers; so that, on the appointed day (5th July, 1948), the routine day-to-day 8 work continued to be carried out by the same medical, dental, nursing and administrative staff working in the same premises as before. DOMESTIC HELP SERVICE. There is a gradually-increasing number of applications for domestic help on behalf of certain types of patients (aged and infirm, chronic sick and tuberculous) for whom accommodation cannot be found in institutions owing to the shortage of hospital beds, and the prevalent shortage of beds will probably prove to be a great strain on available domestic help facilities for some time to come. Since its inauguration in 1946, the domestic help service has grown rapidly; and, even without the additional expansion which will be required to meet the shortage of hospital beds, I anticipate that it will manifest the growth of any healthy young organism by progressive expansion until it becomes one of the most important of the local health services. There has been a progressive increase in the amount of help supplied and in the number of domestic helpers employed, and fuller information regarding the service is given on pages 90 to 96. STAFF. As was the case during 1947, one of the outstanding problems of 1948 was the difficulty of recruiting the staff necessary to carry out essential services. Dr. Hilda Menzies, Deputy Medical Officer of Health, left the Council's service at the end of September on her appointment as Senior Administrative Officer for Maternity and Child Welfare, County of Essex, and Dr. Mary Gilchrist was promoted to fill the appointment of Deputy Medical Officer of Health vacated by Dr. Menzies. The vacancy for Assistant Medical Officer of Health, caused by Dr. Gilchrist's promotion, had not been filled by the end of the year, when it appeared that it may not be filled for many months. At the end of July, 1947 the then Deputy Medical Officer of Health (Dr. Rennie) left the Council's service on his appointment as Medical Officer of Health, City of Carlisle, and it was not until April, 1948 that the vacancy caused by Dr. Menzies' promotion as Deputy was filled. It will be seen that from July, 1947 until December, 1948—a period of some eighteen months—the department has been short of the services of an Assistant Medical Officer for as long as twelve months. During these periods of shortage of 9 medical staff it is necessary either to curtail existing medical services or to endeavour to carry on with such temporary part-time medical assistance as may be available; but the engagement of temporary part-time assistance is unsatisfactory and uneconomic. For these reasons consideration should be given to the advisability of expediting the procedure in filling vacancies which may arise in the permanent medical staff of the department. On pages 71 to 73 of this report will be found observations on the shortage of dental surgeons and the disastrous effect such shortage is having on the dental welfare and health of that section of the community which should enjoy priority in dental treatment —expectant and nursing mothers, pre-school and school children. In spite of steps taken by H.M. Government during recent years to increase the remuneration and conditions of service of nurses and midwives, there is still an acute shortage of health visitors and midwives which makes it not only impossible to enlarge the scope of municipal services, but unduly difficult to carry on without the curtailment of existing services. In addition to the medical Supervisor of Midwives (Dr. Mary Gilchrist), the Health Authority has approved the appointment as non-medical Supervisor of Midwives of Miss E. M. Wearn, S.R.N., S.C.M., who, in addition to being a Queen's Nurse, holds the Health Visitors' Certificate and is an Approved Teacher of Midwifery. Miss Wearn, in her capacity as Matron, Essex County Training Home, Beachcroft Road, has been closely associated with the Council's domiciliary service during her tenure of office, and her designation as non-medical Supervisor of Midwives is welcomed. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Vital Statistics 12 Extract from Vital Statistics for the year 1948. Population 106,100 Live Births:— Legitimate Males 921 Females 840 Illegitimate Males 25 Females 24 Totals 1,810 Birth Rate per 1,000 of population 17.06 Stillbirths:— Males 14 Females 13 Rate per 1,000 total (live and still) births 14.69 Deaths:— Males 571 Females 547 Totals 1,118 Death Rate per 1,000 10.53 Number of women dying from diseases and accidents of pregnancy and childbirth:— From Sepsis 1 From other causes 2 Rate per 1,000 total (live and still) births 1.63 Death rate of infants under one year of age:— All infants per 1,000 live births 20.99 Legitimate infants per 1,000 legitimate live births 21.57 Illegitimate infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 189 „ „ Measles (all ages) 0 „ „ Whooping Cough (all ages) 3 „ ,, Diarrhœa (under 2 years of age) 3 13 BIRTH AND DEATH RATES, 1892—1948. Births =Red. Deaths=Black. (Rate per 1,000 of Population.) 14 INFANT MORTALITY, 1918-48. (Rate per 1,000 births.) 15 TABLE 1. Registered Births, 1948. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall Wanstead Slip. Total. January 6 14 4 7 15 6 7 8 5 8 80 February 8 8 2 6 8 6 4 2 6 5 55 March 4 5 7 4 6 4 7 2 2 2 43 April 4 10 4 7 11 6 4 8 4 4 62 May 5 8 7 3 4 5 6 6 6 6 56 June 3 9 4 2 9 3 3 5 5 – 43 July 5 11 9 3 15 7 5 8 5 2 70 August 3 3 4 3 6 4 1 6 5 4 39 September 2 4 5 6 6 5 7 3 3 6 47 October 2 4 4 4 16 8 5 3 5 8 59 November 3 6 3 4 4 7 7 2 1 3 40 December 6 4 8 4 4 5 1 4 5 3 44 Transferables 72 213 103 120 226 161 84 79 70 44 1,172 Totals 123 299 164 173 330 227 141 136 122 95 1,810 16 TABLE 2. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1948. Sex. All Ages. Ages at Death is 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 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever M 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough M 1 1 ... ... ... ... ... ... ... ... ... ... ... ... F 2 l 1 ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system M 23 ... ... ... ... 4 5 2 5 3 4 ... ... ... F 24 ... ... ... ... 8 6 2 1 3 3 1 ... ... 7. Other forms of tuberculosis M 3 ... ... 1 ... ... 1 ... ... ... 1 ... ... ... F 2 ... 1 ... ... 1 ... ... ... ... ... ... ... ... 8. Syphilitic disease M 4 ... ... ... ... ... ... ... 1 1 1 1 ... ... F 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 9. Influenza M 2 1 ... ... ... ... ... ... 1 ... ... ... ... ... F 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 10. Measles M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) M 7 ... ... ... ... ... ... ... ... 1 2 4 ... ... 13. Cancer of uterus F 12 ... ... ... ... ... ... 1 l 4 2 4 ... ... 14. Cancer of stomach and duodenum M 18 ... ... ... ... ... 1 1 1 3 6 6 ... ... F 7 ... ... ... ... ... ... ... ... 3 1 3 ... ... 17 15. Cancer of breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 17 ... ... ... ... ... 1 1 6 1 6 2 ... ... 16. Cancer of all other sites M 84 ... ... ... ... ... 3 3 15 18 31 14 ... ... F 44 ... ... ... ... ... ... 3 6 10 10 15 ... ... 17. Diabetes M 4 ... ... ... ... ... ... ... ... 1 2 1 ... ... F 6 ... ... ... ... ... ... ... ... 1 3 2 ... ... 18. Intra-cranial vascular lesions M 44 ... ... ... ... ... ... 1 1 6 15 21 ... ... F 78 ... ... ... ... ... ... ... 5 13 26 34 ... ... 19. Heart disease M 148 ... ... ... ... ... ... 4 13 20 57 54 ... ... F 175 ... ... ... ... ... 1 3 6 20 51 94 ... ... 20. Other diseases of circulatory system M 21 ... ... ... ... ... 1 ... ... 4 8 8 ... ... F 22 ... ... ... ... ... ... ... ... 2 8 12 ... ... 21. Bronchitis M 72 1 ... ... ... ... ... 1 4 17 26 23 ... ... F 34 ... ... ... ... ... ... ... 1 4 6 23 ... ... 22. Pneumonia M 26 3 1 1 1 ... ... ... 1 4 4 11 ... ... F 18 ... 1 ... ... ... ... 1 1 2 3 10 ... ... 23. Other respiratory diseases M 4 ... ... ... ... ... ... ... ... 2 1 1 ... ... F 7 ... ... ... ... ... ... 1 ... 2 1 3 ... ... 24. Ulceration of the stomach or duodenum M 7 ... ... ... ... ... ... 2 2 1 1 1 ... ... F 4 ... ... ... ... ... ... ... ... 1 2 1 ... ... 25. Diarrhœa (under 2 years of age) M 2 2 ... ... ... ... ... ... ... ... ... ... ... ... F 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 26. Appendicitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 27. Other digestive diseases M 12 ... ... ... ... ... ... ... 2 6 2 2 ... ... F 11 ... ... 1 1 ... ... ... ... 2 2 5 ... ... 28. Nephritis M 6 ... ... ... ... 1 1 1 ... ... ... 3 ... ... F 9 ... ... ... ... ... ... 1 3 3 1 1 ... ... 29. Puerperal and post-abortive sepsis. F 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 30. Other maternal causes F 2 ... ... ... ... 1 ... 1 ... ... ... ... ... ... 31. Premature birth M 5 5 ... ... ... ... ... ... ... ... ... ... ... ... F 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 32. Congenital malformations M 15 12 1 1 ... ... ... 1 ... ... ... ... ... ... F 10 8 1 1 ... ... ... ... ... ... ... ... ... ... 33. Suicide M 9 ... ... ... ... 2 3 ... 2 ... 1 1 ... ... F 6 ... ... ... ... ... 2 1 1 2 ... ... ... ... 34. Road traffic accidents M 9 ... ... ... 3 ... 1 ... ... 3 1 1 ... ... F 2 ... ... ... 1 ... ... ... ... 1 ... ... ... ... 35. Other violent causes M 4 ... ... ... ... 1 ... ... ... 1 2 ... ... ... F 8 ... ... ... ... ... 2 ... ... ... 1 5 ... ... 36. All other causes M 40 ... 1 1 3 1 ... 2 1 5 10 16 ... ... F 38 ... ... 1 1 ... 4 5 5 2 2 18 ... ... Totals M 571 38 8 7 11 20 32 39 85 173 304 401 1,244 374 F 547 18 TABLE 3. DEATHS IN WARDS, 1948 CAUSES OF DEATH. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. 1 2 3 4 5 6 7 8 9 10 11 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal fever ... ... ... ... ... ... 1 ... ... ... 3. Scarlet fever ... ... ... ... 1 ... ... ... ... ... 4. Whooping cough ... ... 2 ... ... ... ... ... ... 1 5. Diphtheria ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system 3 4 3 5 8 4 7 7 2 4 7. Other forms of tuberculosis ... 1 1 ... 2 ... ... ... 1 ... 8. Syphilitic diseases ... 1 ... 2 ... ... ... 1 ... 1 9. Influenza 1 1 ... 1 ... ... ... ... ... ... 10. Measles ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyeltis and polio-encephalitis ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) 2 ... ... ... 2 ... ... ... 2 1 13. Cancer of uterus ... 2 ... 2 1 3 ... 1 2 1 14. Cancer of stomach and duodenum 1 5 2 5 ... 2 5 2 2 1 15. Cancer of breast 1 3 2 1 2 2 3 ... 3 ... 16. Cancer of all other sites 10 18 15 16 13 20 7 14 9 6 17. Diabetes 1 6 ... ... 3 ... ... ... ... ... 18. Intra-cranial vascular lesions 12 17 6 13 19 15 11 12 11 6 19. Heart disease 25 46 15 25 58 43 29 34 32 16 20. Other diseases of circulatory system 4 8 5 7 8 6 3 1 ... 1 21. Bronchitis 9 11 7 8 17 13 9 11 13 8 22. Pneumonia 3 8 2 5 8 8 3 4 3 ... 23. Other respiratory diseases ... 3 ... 1 1 1 ... 1 2 2 24. Ulcer of stomach or duodenum ... 1 ... 2 1 1 ... 5 1 ... 25. Diarrhoea (under 2 years) ... ... ... ... 1 ... 1 ... 1 ... 26. Appendicitis ... ... ... ... 1 ... ... ... ... ... 27. Other digestive diseases 3 5 2 1 5 1 2 1 2 1 19 28. Nephritis 1 5 1 1 ... 4 ... 3 ... ... 29. Puerperal and post-abortive sepsis ... ... ... ... 1 ... ... ... ... ... 30. Other maternal causes ... 1 ... 1 ... ... ... ... ... ... 31. Premature birth 1 1 1 1 1 ... 1 ... ... 1 32. Congenital malformations ... 2 2 1 8 4 1 2 ... 5 33. Suicide ... 5 2 ... 3 3 ... ... 2 ... 34. Road Traffic accidents 1 2 2 ... 4 ... 1 ... ... 1 35. Other violent causes ... 1 1 ... 3 1 ... 4 1 1 36. All other causes 5 19 5 8 8 10 3 9 8 3 Totals 83 176 76 106 179 141 87 112 97 61 20 TABLE 4. Vital Statistics of Whole District during 1948 and Previous Years. Year. Births. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Inward Transferases 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 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 1948 1172 1810 17.06 2152 20.2 1244 210 38 20.99 1118 10.53 21 TABLE 5. Birth-rate, Death-rate and Analysis of Mortality During the Year 1948 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. Tuberculosis. Pneumonia. 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 17.9 0.42 10.8 0.00 ... 0.51 0.41 0.02 0.00 0.03 3.3 34 ... ... ... 126 County Boroughs and Great Towns, including London 20.0 0.52 11.6 0.00 ... 0.59 0.38 0.02 0.00 0.03 4.5 39 ... ... ... ... 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 19.2 0.43 10.7 0.00 ... 0.46 0.36 0.02 0.00 0.04 2.1 32 ... ... ... ... London 20.1 0.39 11.6 0.00 ... 0.63 0.54 0.01 0.01 0.02 2.4 31 ... ... ... ... LEYTON 17.06 0.25 10.5 0.00 ... 0.49 0.41 0.02 0.00 0.02 1.6 21 80.86 4.38 14.76 ... 22 TABLE 6. Comparative Statistics of Births, Mortality, Etc. LEYTON, 1899-1948. Year. Population. Births. Birth Rate. Deaths. Death Rate. Deaths under 1 year. Infantile Death Rate. 1899 93000 2698 29.0 1262 13.5 420 155 1900 100000 2932 29.32 1179 11.8 410 140 1901 100000 2963 29.63 1243 12.4 404 136 1902 100000 3152 31.52 1183 11.8 336 106 1903 102000 3273 32.08 1112 10.9 322 99 1904 104000 3198 30.07 1370 13.1 444 138 1905 105000 3209 30.05 1177 11.2 303 94 1906 108000 3344 30.9 1327 12.2 382 114.5 1907 120000 3190 26.6 1269 10.6 182 86.6 1908 121200 3071 25.3 1185 9.8 242 78.8 1909 121200 2979 24.6 1208 9.9 244 81.9 1910 123300 3011 24.4 1112 9.0 191 63.4 1911 124736 2931 23.5 1473 11.8 327 116.6 1912 126700 2797 22.1 1343 10.6 223 79.7 1913 129366 2904 22.4 1336 10.3 242 83.3 1914 130847 2800 21.4 1363 10.4 219 78.2 1915 124497 2655 21.3 1510 12.1 225 84.7 1916 B132107* 2560 19.4 1471 12.1 197 76.9 D121420* 1917 B125352* 2005 16.0 1414 12.6 172 85.8 Dl12452* 1918 B125352* 1791 14.3 1723 15.3 161 89.9 Dl12452* 1919 B129062* 2195 17.0 1397 11.3 154 70.16 D123896 1920 128832* 3168 24.6 1330 10.3 207 65.34 1921 128432 2679 20.86 1290 10.04 182 67.94 1922 131600 2416 18.36 1420 10.79 155 64.16 1923 132800 2328 17.53 1228 9.25 106 45.53 1924 133500 2101 15.74 1325 9.92 110 52.36 1925 132700 2091 15.76 1349 10.16 114 54.51 1926 130000 2022 15.55 1261 9.7 131 64.79 1927 128920 1826 14.16 1322 10.25 80 43.81 1928 130300 1853 14.22 1290 9.90 91 49.10 1929 128300 1731 13.49 1510 11.76 100 57.77 1930 128300 1757 13.69 1222 9.52 81 46.09 1931 128600 1812 14.09 1365 10.61 71 39.18 1932 127140 1666 13.10 1341 10.54 89 53.43 1933 125700 1499 11.91 1468 11.67 76 50.70 1934 123430 1454 11.78 1317 10.67 64 44.02 1935 121690 1493 12.26 1225 10.06 60 40.18 1936 119900 1421 11.85 1272 10.61 74 52.07 1937 118100 1420 12.02 1349 11.42 75 52.81 1938 117200 1509 12.87 1148 9.79 70 46.38 Bl16100* 1939 Dl10800* 1499 12.90 1242 11.21 46 31.65 1940 96500 1353 14.02 1563 16.2 50 39.03 1941 84790 1129 13.31 1142 13.46 37 38.30 1942 86960 1452 16.69 1123 12.91 73 50.27 1943 87880 1595 18.14 1248 14.20 57 35.73 1944 85440 1613 18.87 1285 15.04 68 42.15 1945 87330 1474 16.87 1147 13.13 52 35.27 1946 101910 2223 21.81 1181 11.58 64 28.78 1947 105550 2359 22.35 1278 12.10 78 33.06 1948 106100 1810 17.06 1118 10.53 38 20.99 * Population aa estimated for purposes of b Birth Rate, d, Death Rate. 23 TABLE 7. Infantile Mortality, Year 1948—Ages. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Smallpox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... 1 ... 1 2 Diphtheria and croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... 1 ... ... 1 Tuberculous meningitis ... ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... 1 2 ... ... 3 Diarrhœa ... ... ... ... ... 2 ... ... ... 2 Enteritis ... ... ... ... ... ... ... 1 ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 5 ... ... ... 5 ... ... ... ... 5 Atelectasis 5 1 ... ... 6 ... ... ... ... 6 Congenital malformations 2 ... 2 ... 4 2 1 2 ... 9 Premature birth 7 ... ... ... 7 ... ... ... ... 7 Atrophy, debility and marasmus ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... ... ... ... 1 ... 1 Totals 19 1 2 ... 22 6 5 4 1 38 Nett Births registered during the calendar year Legitimate ... 1,761 Illegitimate ... 49 Nett Deaths registered during the calendar year ' Legitimate infants ... 38 Illegitimate infants ... Nil Infectious Diseases 26 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 Hospital. Smallpox ... ... Diphtheria 5 5 Erysipelas 35 3 Scarlet Fever 160 73 Pemphigus Neonatorum ... ... Pulmonary Tuberculosis 130 ... Tuberculosis, other forms 14 ... Pneumonia 155 93 Ophthalmia Neonatorum 3 ... Typhoid Fever ... ... Paratyphoid Fever 1 1 Puerperal Pyrexia 10 9 Cerebrospinal Meningitis 4 4 Poliomyelitis 1 1 Polioencephalitis 1 1 Encephalitis Lethargica ... ... Dysentery 4 3 Measles 1,088 33 Whooping Cough 623 29 Malaria ... ... Totals 2,234 255 27 SMALLPOX. During the year no case of smallpox occurred in the area. Vaccinal State of Children examined at Routine Medical Inspection. Under the provisions of the National Health Service Act, 1946, the Vaccination Acts were repealed. On and after 5th July, 1948 vaccination ceased to be compulsory, and it will be interesting to see what effect the removal of compulsion will have on the proportion of children protected by vaccination. It has been realised for some time that a relatively small proportion of children are now being vaccinated. 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 seven 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 1948 3,280 1,172 35.7 Total ... 21,299 6,088 28.1 SCARLET FEVER. During 1948 the incidence of scarlet fever was low, and the disease remained of the mild type to which we have become accustomed during recent years. One male child (7 years) died from cardiac failure resulting from rheumatic carditis following an attack of scarlet fever, and the death is therefore attributable to scarlet fever. the death is therefore attributable to scarlet fever. This is the first death from scarlet fever since 1941. 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 1948 160 1 0.62 28 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 1948 5 0 0.00 TUBERCULOSIS. Notifications.—One hundred and forty-four patients were notified for the first time in 1948 as suffering from tuberculosis. The number was made up as follows:- Males. Females. Total. Pulmonary Tuberculosis 60 70 130 Non-Pulmonary Tuberculosis 9 69 5 75 14 144 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1948:— Pulmonary. Non-Pulmonary. TOTAL M. F. Total. M. F. Total. Number on Register at commencement of year 311 203 514 19 41 60 574 Number first notified during the year 60 70 130 9 5 14 144 Number of cases entered in Register otherwise than by Notification 17 11 28 ... 2 2 30 Number removed from the Register during the year 41 30 71 2 5 7 78 Number remaining at the end of the year 347 254 601 26 43 69 670 Details of cases removed from the Register during the year:— Died 26 22 48 1 1 2 50 Removed from the district 9 6 15 ... ... ... 15 De-notified 6 2 8 1 4 5 13 29 Deaths.—Fifty-two 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 1 — 5 1 1 — 1 10 1 — 2 — 15 4 12 2 — 20 7 15 1 2 25 17 19 1 1 35 10 7 — — 45 12 6 1 — 55 2 6 — 1 65 and upwards 4 3 1 — Totals 60 70 9 5 Statistical Summary. The following tables have been compiled to show the annual numbers of new cases and deaths over a period of ten years. 30 TUBERCULOSIS. NOTIFICATIONS. Year. Pulmonary. Non-Pulmonary. Total. M. F. Total. M. F. Total. 1939 56 42 98 3 6 9 107 1940 49 33 82 11 13 24 106 1941 57 45 102 7 5 12 114 1942 64 27 91 7 6 13 104 1943 51 50 101 11 6 17 118 1944 43 41 84 11 10 21 105 1945 71 40 111 6 5 11 122 1946 61 30 91 6 11 17 108 1947 50 39 89 4 5 9 98 1948 60 70 130 9 5 14 144 DEATHS. Year. Pulmonary. Non-Pulmonary. Total. M. F. Total. M. F. Total. 1939 32 24 56 5 2 7 63 1940 44 18 62 7 4 11 73 1941 24 23 47 4 4 8 55 1942 40 27 67 6 2 8 75 1943 38 24 62 6 2 8 70 1944 30 26 56 4 4 8 64 1945 20 15 35 3 3 6 41 1946 27 17 44 2 1 3 47 1947 24 17 41 1 3 4 45 1948 23 24 47 3 2 5 52 31 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1948. DISEASE. Total. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 5 ... 3 ... ... 1 ... ... 1 ... ••• 5 Erysipelas 35 4 7 ... 7 8 1 2 1 3 2 3 Scarlet Fever 160 17 25 16 22 20 8 8 14 24 6 73 Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 130 19 18 5 13 25 20 7 5 8 10 ... T.B. Others 14 ... 5 ... ... 4 ... 1 1 1 2 ... Pneumonia 155 13 16 16 24 25 26 7 6 15 7 93 Ophthalmia Neon 3 ... ... ... ... ... ... ... ... 2 1 ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 Puerperal Pyrexia 10 1 4 2 1 1 1 9 Cerebrospinal Meningitis 4 ... ... 1 1 ... ... 1 ... ... 1 4 Poliomyelitis 1 ... ... ... ... ... ... ... ... ... 1 1 Polioencephalitis 1 1 ... ... ... ... ... ... ... ... ... 1 Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 4 ... 1 ... 1 2 ... ... ... ... ... 3 Measles 1088 117 244 119 122 200 121 42 75 23 25 33 Whooping Cough 623 27 99 31 56 125 91 35 33 69 57 29 Malaria ... ... ... ... ... ... ... ... ... ... ... ... Totals 2234 199 422 188 246 413 268 104 136 146 112 255 32 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1948. 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 5 1 ... ... ... 1 1 ... ... 1 1 ... ... Erysipelas 35 1 ... ... ... ... 1 ... 1 6 3 15 8 Scarlet Fever 160 3 5 11 14 30 78 12 5 1 ... 1 ... Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 130 ... 1 1 ... 1 2 1 16 58 17 26 7 T.B. Others 14 ... ... 1 ... ... 1 2 2 5 ... 2 1 Pneumonia 155 16 1 6 4 3 19 3 1 21 18 37 26 Ophthalmia Neon. 3 3 ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 1 ... ... ... ... ... ... 1 ... ... ... ... ... Puerperal Pyrexia 10 ... ... ... ... ... ... ... ... 8 2 ... ... Cerebrospinal Meningitis 4 1 2 ... 1 ... ... ... ... ... ... ... ... Poliomyelitis 1 ... ... ... ... 1 ... ... ... ... ... ... ... Polioencephalitis 1 ... ... ... ... ... 1 ... ... ... ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 4 ... ... ... 2 1 ... ... 1 ... ... ... ... Measles 1088 56 144 147 148 142 432 14 1 3 1 ... ... Whooping Cough 623 68 100 75 86 112 177 4 ... 1 ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 2234 149 253 241 255 291 712 37 27 104 42 81 42 General OUTBREAK OF FOOD POISONING. SCABIES CLINIC. PUBLIC MORTUARY. 34 OUTBREAK OF FOOD POISONING. On Saturday, 26th June, a celebration party was held at a private house in the Borough. The menu (lunch and supper) consisted of:— Lunch.—Chicken, potatoes and salad. Tinned apricots, peaches and prunes. Supper.—Fried plaice and salad. Minerals and intoxicants. Some 37 persons were present at the party and partook of the meals supplied there. In addition, fried fish was sent out to the homes of some 13 friends who were unable to stay to supper. On Monday, 28th June, information was received that three persons, resident in Ilford, had been admitted to hospital suffering from acute food poisoning which began a few hours after eating the fried fish which had been sent to their homes ; and that a family in Bethnal Green was suffering from acute gastro-enteritis after eating fish sent from the same house. The house where the party was held was visited immediately, and a list was obtained of all persons who attended the party. The Medical Officers of Health of the areas concerned were then notified. Source of Infection. Early in the investigation it was established that the only article of food consumed by all infected persons was fried fish, and that no person was affected who did not partake of the fish. Unfortunately, by the time the first cases were brought to my notice, all the fried fish had been consumed or destroyed, and there was none left for chemical or bacteriological investigation. One very baffling feature of this outbreak was that in the first three cases reported (severe cases removed to hospital), the onset of symptoms was as early as two hours after eating the fish— suggestive of staphylococcal infection ; whereas in the remainder of the cases the onset of symptoms did not occur until from 12 to 24 hours—suggestive of salmonella infection. The fish (plaice) was supplied and cooked by a friend of the family who has a small restaurant in London. It was dipped in pickled hens' eggs and fried at the London restaurant on the evening before the party. There it was kept all night, wrapped in grease-proof paper, and transported next morning in the cook's private motor car to the house where the party was to take place later in the day. It was delivered at 10 a.m., stored on a table in a back sitting-room until 8 p.m., when it was removed from the grease-proof paper and served cold (on plates) to the assembled 35 guests. The mother insisted that no one other than herself handled the fish from the time it arrived in the house, and she took what appeared to be a justifiable pride in the fact that she " with her own hands " had served all the fish to such a large gathering. Up to that stage in the investigation the finger of suspicion was naturally pointed towards the two persons chiefly concerned with the cooking and handling of the fish—the cook and the mother ; but subsequent investigation showed—at least as far as such an investigation can show—that they were not the carriers of the infection. The mother, who served and handled all the fried fish, was found to be bacteriologically negative, and could not be regarded as a carrier of infection. The restaurateur, who prepared and fried the fish, had a history of ' gastric trouble ' for over two years, but cultures from his stools showed no evidence of pathogenic organisms. Under the circumstances it was necessary to investigate other possible, although less probable, sources. The premises where the fish was cooked were thoroughly investigated by the Medical Officer of Health of the area, but nothing was found which could account for the infection of the fish there. The eggs and batter, in which the fish was fried, were examined. In the house where the party was held there was a pet dog, and some evidence of infestation by mice ; but a rectal swab from the dog, and a dead mouse submitted to bacteriological examination, were found to be free from pathogenic organisms. The bacteriological examinations, therefore, failed to reveal any definite source from which the fish was infected by salmonella organisms. Statistical Summary. The following figures give in statistical form the relevant facts connected with the outbreak:— STATISTICAL SUMMARY OF OUTBREAK. Number of Persons who— At Party. At Home. Total. Ate the fried fish 33 13 46 Developed symptoms of gastro-enteritis 6 10 16 Removed to hospital 1 8 9 Rectal swabs positive 4 9 13 Did not develop symptoms 27 3 30 Rectal swabs positive 3 - 3 Of the 46 persons who ate the fried fish, bacteriological examination of the rectal swabs disclosed the presence of Salmonella (Typhimurium) infection in 16 cases. 36 Observations. These figures disclose that the severity of symptoms, as judged by the necessity of removal to hospital, was much greater among those who consumed the fish in their own homes than among those who ate it at the party ; in fact the only person in the latter category who was removed to hospital was not seriously ill, and was removed more for public health reasons than for treatment. Progress of Cases. All infected persons made uninterrupted recoveries, and bacteriological investigation showed that by 1st September, 1948 all persons infected were quite free from infection. SCABIES. In order to provide facilities for dealing with the increased prevalence of scabies and verminous conditions at that time, a Special Clinic and Cleansing Centre was established in Ruckholt Road School in the early part of 1942. The following figures show the work done at that Clinic since then. Year Cases Treated Total attendances for treatment Children Adults Total 1942 (10 mths.) - - 303 1291 1943 522 632 1154 2490 1944 328 517 845 1990 1945 302 454 756 1462 1946 261 402 663 1298 1947 91 156 247 495 1948 67 90 157 271 Attendances during 1948. Number of patients treated 157 Children 67 Adults 90 Number of patients who had One routine treatment 157 Two „ „ 69 Three „ „ 6 Local treatment, no bath 39 271 37 PUBLIC MORTUARY. Number of bodies deposited, death being due to:— Natural causes 67 Suicide 9 Accidents 6 82 Number of Post-mortem examinations performed 82 Number of Inquests held 17 In 65 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 18 ,, occlusion-atheroma 4 Myocardial degeneration 6 Mitral stenosis 2 Rheumatic carditis 3 Aortic incompetence—specific 1 Aneurysm of aorta—specific 3 Cerebral haemorrhage 2 Hypertension 8 Pneumonia 4 Suppurative bronchitis 4 Pulmonary tuberculosis 2 Emphysema 1 Pulmonary thrombosis I Strangulated hernia 1 Hyaline Necrosis 2 Cancer stomach 1 Sarcoma of temple bone. 1 Ruptured lung 1 Inquests. The following verdicts on Leyton residents were recorded at inquests held during the year:— Accidental 23 Suicide 15 Natural causes 3 Open verdict 1 Murder 1 Misadventure 6 Sanitary Circumstances of the Area 40 SANITARY CIRCUMSTANCES OF THE AREA. SANITARY INSPECTIONS OF THE AREA. Inspections. The table below gives a summary of the Inspections made by the Sanitary Inspectors:— Number of dwelling-houses inspected 3,330 Miscellaneous inspections 2,303 Re-inspections 13,826 Places of entertainment 18 Schools 23 Stables 27 Urinals 94 Visits in connection with infectious diseases 309 Factories without mechanical power 35 Factories with mechanical power 145 Rag and bone dealers 2 Foster-mothers' premises 4 Hairdressers' premises 36 Public Houses 19 Offensive Trades 75 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 706 Sashcords renewed 276 Plaster repaired 1,432 Roofs repaired or renewed 1,308 Guttering repaired or renewed 518 Yards paved 61 Drains relaid or partly relaid 54 Choked drains cleared 68 New w.c. pans and traps provided 104 Sinks provided 42 W.c. cisterns repaired or renewed 186 Rain water pipes repaired or renewed 351 Vent pipes repaired or renewed 81 Sink waste pipes repaired or renewed 120 Stoves repaired or renewed 394 Coppers repaired or renewed 29 41 Floors repaired 521 Rooms redecorated 1,565 Windows, sills, etc., repaired 719 Cement work to sink waste gullies repaired 86 Miscellaneous defects remedied 802 Drainage. The drains of 91 houses were reconstructed. In some instances the reconstruction related to portions of the public sewers, and in these cases the work was carried out under the supervision of the staff of the Borough Engineer and Surveyor's Department, the expenses incurred thereby being recovered from the owners. Verminous Houses. Infested. Disinfested. Number of houses 189 189 Rats and Mice (Destruction) Act, 1919. Ministry of Food—Infestation Order 1943 S. R. & O. 680. Complaints Complaints received and investigated 572 Premises not treated (not genuine infestation) 32 Premises treated:— (a) Dwelling-houses 459 (b) Business premises 81 540 Premises freed 502 Sewer Maintenance Treatments. All sewers in the Borough were treated in July, 1948 (followed by a further treatment in January, 1949). The following figures show the results of these two treatments: No. of Manholes baited. No. showing complete prebait take. No. showing some prebait take. Percentage of take. 1st Treatment 1,010 95 236 32.77 2nd Treatment 1,167 239 256 42.24 42 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 2,369 complaints were received and investigated. The nature of the complaints included sanitary defects in houses, drains choked or defective, premises infested with vermin, etc. Notices. Notices served—Informal 1,983 Statutory—Housing Acts Nil Public Health Acts 678 Notices complied with—Informal 2,093 * Statutory— Housing Acts Nil Public Health Acts 518* *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 57 Flats 18 Temporary housing 52 (ii) By other Local Authorities Nil (iii) By other bodies and persons— Houses 67 Flats Nil 43 (6) 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 57 Flats 18 Temporary housing 52 (6) 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) 3,330 (6) Number of inspections made for the purpose 17,156 (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 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,983 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 2,093 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 44 (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 678 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 518 (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 1,314 houses 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 1,466 enquiries. 45 Smoke Abatement. During the year 129 observations have been made on factory chimneys. Infringements were found in two instances, and letters of warning were issued in these cases. It was not found necessary to institute legal proceedings. Repairs. The number of complaints received from occupiers of dwellinghouses has increased during the year with respect to general defects and inadequate accommodation. This is undoubtedly due to the fact that during the war period essential repairs were not carried out and also the inability to build new houses. Owing to the acute housing shortage it has not been possible to deal with slum clearance areas and demolition of individual houses. Many overcrowded dwellings and undesirable conditions have still therefore to be tolerated. Notices to remedy insanitary conditions have resulted in 2,611 houses being brought up to a reasonable standard of fitness. It has been necessary to institute legal proceedings in 35 instances, and the following list shows the result of such action:— Legal Proceedings. (Public Health Act, 1936.) Non-compliance with Abatement Notice:— 1. 17/3/48 19/21, Frith Road. Case adjourned for one month. 2. 24/3/48 3, Avenue Road. Nuisance Order made (28 days). 3. 24/3/48 7, Avenue Road. Nuisance Order made (28 days). 4. 14/4/48 19/21, Frith Road. Five guineas costs. 5. 28/4/48 161, Ramsay Road. Adjourned for 21 days. 10/6 costs. 6. 28/4/48 163, Ramsay Road. 10/6 costs. 7. 28/4/48 165, Ramsay Road. 10/6 costs. 8. 28/4/48 167, Ramsay Road. 10/6 costs. 9. 19/5/48 161, Ramsay Road. Two guineas costs. 10. 19/5/48 21, Lansdowne Road. Dismissed under Probation of Offenders Acts. Two guineas costs. 11. 19/5/48 23, Lansdowne Road. Dismissed under Probation of Offenders Acts. Two guineas costs. 12. 17/6/48 Delivery of certain articles to persons under 14 years, contrary to Sec. 154 of the Public Health Act, 1936. Found guilty. Fined 20/-. 13. 17/6/48 Do. Found guilty. Fined 10/-. 46  Non-compliance with Abatement Notice:— 14. 24/6/48 2, Cecil Road. Nuisance Order made (28 days). Two guineas costs. 15. 7/7/48 5, Cowley Road. Nuisance Order made (28 days). Two guines costs. 16. 7/7/48 283, Harrow Road. Nuisance Order made (28 days). Two guineas costs. 17. 7/7/48 287, Harrow Road. Nuisance Order made (28 days). 18. 14/7/48 44, Peterborough Road. Nuisance Order made (28 days). Two guineas costs. 19. 14/7/48 11, Carlisle Road. Nuisance Order made (28 days). 20. 28/7/48 15, Stanley Road. Nuisance Order made (28 days). 21. 28/7/48 11, Trinity Street. Nuisance Order made (28 days). Two guineas costs. 22. 28/7/48 128, Sidmouth Road. Nuisance Order made (28 days). Two guineas costs. 23. 25/8/48 28, Temple Street. Nuisance Order made (28 days). Two guineas costs. 24. 25/8/48 45, William Street. Nuisance Order made (28 days). Two guineas costs. 25. 15/9/48 26, Hall Road. Nuisance Order made (28 days). Two guineas costs. 26. 15/9/48 36, Beaumont Road. Nuisance Order made (28 days). Two guineas costs. 27. 6/10/48 11, Florence Road. Nuisance Order made (28 days). 40/- costs. 28. 6/10/48 171, Capworth Street. Nuisance Order made (28 days). 40/- costs. 29. 6/10/48 95, Forest Road. Nuisance Order made (3 months). 30. 6/10/48 14, Cecil Road. Nuisance Order made (28 days). 31. 20/10/48 2, Ramsay Road. Nuisance Order made (28 days). 32. 20/10/48 58, Granleigh Road. Nuisance Order made (28 days). 33. 20/10/48 60, Granleigh Road. Nuisance Order made (28 days). 34. 3/11/48 138, Beaumont Road. Nuisance Order made (28 days). Two guineas costs. 35. 3/11/48 10, Forest Glade. Nuisance Order made (28 days). Two guineas costs. 36. 3/11/48 10, Russell Road. Nuisance Order made (28 days). Two guineas costs. 37. 24/11/48 518, High Road, E.11 Nuisance Order made (two months). 47 INSPECTION AND SUPERVISION OF FOOD. FOOD PREMISES. Preparation and Handling of Food. During the year special attention has been paid to places where food is prepared for sale, including canteens. As a result of advice given to persons engaged in the preparation and handling of food it is satisfying to report that much improvement has been effected in regard to structural conditions and general cleanliness of the premises, utensils and persons. It is found that greater care is being exercised by all concerned and there is a desire by both employers and employees to comply with instructions and advice offered them. Inspections. The following visits were made to food premises during the year:— Slaughter-houses 11 Butchers 288 Bakehouses 105 Fishmongers 141 Milkshops and dairies 81 Provision shops 366 Dining rooms 197 Greengrocers 129 Fish friers 72 Ice cream premises 236 MILK. Dairies and Milkshops. Number of registered premises from which milk is sold 63 Premises added to register during year Nil Premises removed from register during year 1 Visits of inspection 81 48 Bacteriological Examinations. Designated Milk. Licenses. No. Granted. No. of Samples taken. Result Phosphatase Reaction. Methylene Blue Test. Satisfactory. Unsat. Satisfactory. Unsat. Tuberculin Tested 14 — — — — — Accredited 2 — — — — — Pasteurised 38 8 8 — 8 — SupplementaryLicences — — — — — — Tuberculin Tested 3 — — — — — Pasteurised 3 — — — — — Totals 60 8 8 — 8 ICE CREAM. Number of premises registered— As Manufacturers 27 (Of this number only 17 are actually manufacturing at the moment). For Sale or Storage (Of this number only 96 are actually selling at the moment). 163 Number of Samples taken during 1947 76 Results of Samples taken— Satisfactory 55 Unsatisfactory 21 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1948 67 Premises registered during 1948 Nil Premises removed from Register during 1948 Nil MEAT. Slaughter - Houses.—There are six licensed slaughterhouses in the Borough, and 11 inspections of these slaughterhouses were made. 49 Meat and Foods condemned and destroyed. Evap. milk 1,395 tins. Condensed milk 108 „ Luncheon meat 155 „ Soup 173 „ Corned beef 187 „ Vegetables 583 „ Fruit 387 „ Fish 407 „ Jam 276 „ Stewed steak 33 „ Fish 2,631 lbs. Eggs 1,323 Cheese 108½ lbs. Bacon 41½ „ Butter 3½ „ Fat 18¼ „ Tea 21 „ Biscuits 89 „ Meat 48 „ Fowls 234 Poussins 249 Ducks 24 Pheasants 9 Partridges 8 Turkeys 20 Geese 2 Rabbits 66 Tripes 25 Tripes, partly-dressed 6 cwts. Sheeps' heads 100 Weasands 50 Rolls 50 Reeds 50 Sets of feet 13 Meat pies 108 Gooseberries 15 lbs. Dates 24 „ Prunes 124 „ Chocolates and sweets 2½ „ Pickles 80 jars. Miscellaneous 394 pkts. 50 Carcases Inspected and Condemned. No local slaughtering took place during the year. Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 6 Dairies, Milkshops and Dairymen 63 Butchers'shops, Stalls and Provision shops 307 Hairdressers' Premises 79 Fish friers 15 Offensive Trades. Rag and Bone dealers 4 Tripe boiler 1 Contagious Diseases of Animals Acts and Orders. Two notices defining "infected places" in connection with Fowl Pest outbreaks during the year 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 122. Samples analysed. Samples unsatisfactory. Anchovy fillets 1 ... Aniseed, balsam of 1 ... Arrowroot 1 ... Barley crystals 1 ... Boric acid ointment 1 ... Borax and honey 1 ... Butter 1 ... Castor oil 1 ... Cake mixture 4 ... Chicken broth 1 ... Chocolate snacks 1 ... Chewing gum 1 ... Cinnamon 1 ... Coconut squares 1 ... Coffee 1 ... Coffee ("Cup Kaff") 1 ... Coffee and chicory extract 2 ... Cooking oil 1 ... Cough cures 3 ... Crab paste 1 ... 51 Samples analysed. Samples unsatisfactory. Curry powder 1 1 Custard powder 1 ... Dried egg 1 1 Fish spread. 1 ... Gelatine crystals 1 ... Gin 2 ... Ginger, ground 1 ... Golden raising powder 1 ... Golden syrup 1 ... Gravy powder 4 ... Herring fillets 1 ... Jelly crystals 1 ... "Kake-Mako" (cake mixture) 1 ... Lemonade powder 3 ... Luncheon sausage 1 ... Mace, ground 1 ... Margarine 1 ... Milk 47 ... Mustard 1 ... Oatmeal 1 ... Pepper 3 ... Port 1 ... Pudding mixture 1 ... "Rubbing-In" oil 1 ... Rum 1 1 Sage and onion stuffing 1 ... Salad dressing 1 ... Sauce 1 ... Sausage meat 2 ... Saxan (saccharin) 1 ... Seidletz powder 1 ... Semolina 1 ... Soya flour 1 ... Sponge mixture 2 ... Tea 1 ... Veal and ham paste 1 ... Vinegar 1 ... Whisky 2 ... Yeast tablets 1 ... 122 3 52 Lecture to Food Traders. A meeting, the first of the kind to be held within the Borough, took place at the Lecture Hall, Leytonstone Library, in August, 1948. Two hundred representatives were present from the various food traders in the district, as well as members of the Leyton Borough Council. The Chairman of the Public Health Committee (Councillor Mrs. Burrell), who presided, extended a warm welcome to the representatives, and explained the reasons for convening the meeting. A lecture entitled "The Importance of Hygiene in Food Premises" was delivered by the Senior Sanitary Inspector, after which the Chairman invited questions. At the close of the meeting a film "The Town Rat", kindly loaned by the Ministry of Agriculture and Fisheries, was shown. Legal Proceedings. (Food and Drugs Act, 1938.) l. 4/2/48 Pepper adulterated with flour. Case dismissed. 2. 18/2/48 Dirt in Milk. Fined 40/- and two guineas costs. 3. 18/2/48 Do. Fined 40/- and two guineas costs. 4. 23/3/48 Do. Fined £5. 5. 19/5/48 Do. Fined 40/- and one guinea costs. 6. 19/5/48 Do. Fined £25 and two guineas costs. 53 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 273 18 — Factories without mechanical power 35 3 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) — — — Total 308 21 — 2. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) Lack of cleanliness 7 6 — Sanitary Conveniences:— Insufficient 2 2 — Unsuitable or defective 11 11 — Other Offences 13 13 — Total 33 32 — OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937.) Nature of Work. Instances. Notices served. Prosecutions (1) (2) (3) (4) Nil Nil Nil — National Health Service Act, 1946 Part III 56 HISTORICAL. In the year 1912 Leyton Urban District Council began to take a direct and personal interest in the welfare of mothers and young children by appointing a part-time health visitor to undertake the visiting of infants in their homes. Of the many difficulties with which such pioneering health visitors had to contend, one of the chief was that of getting reliable information regarding the number and the whereabouts of the babies they were appointed to visit; and it was to overcome this difficulty that the Notification of Births Act, 1915 was passed. Thereafter notification of birth became compulsory all over the country, and local authorities were given power to undertake maternity and child welfare work. In 1917 Leyton Council established its first municipal Infant Welfare and Ante-Natal Clinics, and appointed a part-time medical officer for maternity and child welfare. Under the provisions of the Maternity and Child Welfare Act, 1918 Leyton Council became a Welfare Authority, and in September of that year established a Maternity and Child Welfare Committee. In 1930 the Borough Council became the Local Supervising Authority under the Midwives' Acts and the authority responsible for the Registration of Nursing Homes. During the thirty years which have elapsed since the Leyton Maternity and Child Welfare Committee came into being (i.e., in 1918) the Council has taken full advantage of its powers to organise and encourage schemes for the welfare of expectant and nursing mothers and of children under five years of age. In that time there has developed in the area a comprehensive municipal maternity and child welfare service which has been greatly appreciated by residents in the Borough. Some idea of the results which have been achieved during these thirty years may be got by comparing the following relevant vital statistics for the years 1918 and 1948. 1918 1948 Births 1,791 1,810 Birth rate 14.3 17.06 Deaths under one year of age 161 38 Infantile mortality rate 89.9 20.9 Maternal mortality rate 6.70 1.63 57 These figures show that, out of every 1,000 children born in Leyton, the number who died before reaching one year of age was almost four times greater in 1918 than in 1948, and that the number of mothers who now die in childbirth is less than a quarter of the rate for the year 1918. During that period the expectation of life has increased by over ten years, i.e., the average child born in 1948 may expect to live at least ten years longer than his parents born thirty years ago. These are impressive figures, showing what organised health services can achieve in one generation. But these vital statistics deal only with births and deaths. To appreciate the full significance of the progress made one has only to compare the health and physique of the infant and pre-school child of to-day with their predecessors of a generation ago. Then quite a large percentage of young children suffered from running noses and discharging ears, from loss or impairment of vision due to ophthalmia at birth, and from crippling defects of many kinds, while their mothers suffered from such debilitating diseases as anaemia and rickets. Nowadays running noses and discharging ears are the exception rather than the rule, blindness and serious impairment of vision due to ophthalmia neonatorum have almost disappeared, and one can travel far before one meets a child suffering from gross physical deformity or crippling defect. The pale, anaemic and rickety young mother is now so rare that her case attracts immediate attention, and she is now more likely to accept the advice of the clinic doctor or nurse rather than that of the misinformed but well-meaning relative or friend. NATIONAL HEALTH SERVICE ACT, 1946. Scope of the Service. The Act provides for the following kinds of health services:— 1. Hospital and Specialist Services. These cover inpatient and out-patient services, the latter including clinics and dispensaries operated as part of any specialist service. The advice and services of specialists of all kinds are also to be made available where necessary, at health centres and in the patient's home. 2. Health Centres and General Practitioner services —i.e., general personal health care by doctors and dentists whom the patient chooses. These personal practitioner services are to be available both from new publicly-equipped health centres and also from the practitioners' own surgeries. 58 3. Various Supplementary Services—including midwifery, maternity and child welfare, health visiting, home nursing, a priority dental service for children and expectant and nursing mothers, domestic help where needed on health grounds, vaccination and immunisation against infectious diseases, additional special care and after-care in cases of illness, ambulance services, blood transfusion and laboratory services. (Special school health services are already provided for in the Education Act of 1944.) 4. The provision of spectacles, dentures and other appliances, together with drugs and medicines—at hospitals, heaLh centres, clinics, pharmacists' shops and elsewhere, as may be appropriate. Administrative Arrangements. In brief outline the following is the administrative set-up:— 1. Regional Hospital Boards, and their local Hospital Management Committees, are now responsible for the hospital and specialist services, including the specialist services of Local Health Authorities. 2. Local Executive Councils are in administrative control of the general medical practitioner and dental services, either from the practitioners' own surgeries or from publicly-equippeed health centres to be established in due course. In addition, the provision of spectacles, dentures, drugs and medicines is the responsibility of Local Executive Councils. 3. Local Health Authorities (County or County Borough Councils—known as "Major Local Authorities") are now responsible for local government services such as maternity and child welfare, vaccination and immunisation, care and after-care, ambulances, blood transfusion and laboratory services. The administration of the new National Health Service is in the hands of these three independently-constituted authorities, each having jurisdiction over a specified branch of the service. But the medical need of the individual citizen does not lend itself to sub-division into three, and the success of the new service will depend primarily on the extent to which these three administrative branches can be intertwined. Close liaison will be necessary, both at authority and officer level, in the interests of public individual welfare ; and this can be brought about most effectively by the inclusion or co-option on each of the three administrative bodies of as many members and officials as possible from the other two. 59 General Practitioner Services—Health Centres. A main feature of the personal practitioner services is to be the development of Health Centres. The object is that the Health Centre system, based on premises technically equipped and staffed at public cost, shall afford facilities both for the general medical and dental services and also for many of the special clinic services of the local health authorities, and sometimes also for outpost clinics of the hospital and specialist services. Besides forming a base for these services, the Centres will also be able to serve as bases for various activities in health education. The Act makes it the duty of the County and County Borough Councils to provide, equip, staff and maintain the new Health Centres to the satisfaction of the Minister. The local authorities will directly administer such of their own local clinic facilites as they may provide in the Centres. Doctors and dentists, however, who use the new Centres while participating in the general personal practitioner service will be in contact only with the new Executive Councils, and it will be for those Councils to arrange with the local authorities for the use of the Centres' facilities by those doctors and dentists. Local Government Services. This part of the health service comprises the local and domiciliary services which are appropriate to local government. The Act unifies these services in the existing Major Local Authorities —the county and county borough councils. For most of these services, the Act required the local health authorities to indicate to the Minister the way in which they intended to carry out their responsibilities, and it required the Minister's general approval. (a) Maternity and Child Welfare and Midwifery. The Act makes it the duty of every local health authority to make arrangements for the care of expectant and nursing mothers and of children under five years of age who are not attending school and who are therefore not covered by the school health service. Their arrangements will include ante-natal clinics for the care of expectant mothers, post-natal and child clinics, the provision of such things as cod liver oil, fruit juices and other dietary supplements and, in particular, a priority dental service for expectant mothers and young children. 60 The Act transfers these functions from such of the present "Minor" Authorities—the non-county boroughs and the district councils—as are at present exercising' them. But, for coordination with the school health services, provision is made for delegating child welfare to "district executives" in the same way—and with the same rights for the minor authorities—as is done for the school health service under the Education Act, 1944. The same authorities—county and county borough councils —are also made the supervising authorities for the purposes of the existing Midwives' Acts; that is to say, they are made responsible for a complete midwifery service for mothers who are confined at home. Mothers who for any reason have their confinements in a hospital or maternity home will be in the care of the hospital and specialist service. It will also be the object of that service to provide locally for all specialist obstetric or gynaecological care which may be needed in relation to the ordinary domiciliary service of the local authority. The requirements of Ministerial approval to the local authority's arrangements will link together the two aspects of the maternity service—domiciliary and institutional. (b) Health Visiting and Home Nursing. It is made the duty of the local health authority to provide for a full health visitor service for all in their area who are sick, or expectant mothers, or those with the care of young children. This widens the present conception of health visiting (as concerned with mother sand children) into a more general service of advice to households where there is sickness or where help of a preventive character may be needed. It is also made the duty of the local health authority to provide a home nursing service for those who—for good reason—need nursing in their own homes. In both of these activities the local authority can, if it likes and if the Minister approves, make all or part of its provision by arrangement with voluntary organisations to act on its behalf. General Observations. It would be idle to expect that such a fundamental and farreaching change in medical and allied services could take place without some dislocation of existing arrangements, and without the appearance of certain difficulties which had not been foreseen 61 when the Act was put on the Statute Book; but it can at least be claimed as an outstanding administrative achievement that the Act came into operation so smoothly and with so little inconvenience to those making use of the services available. Since 'the appointed day' certain administrative difficulties have been brought to light, such as the acute shortage of hospital beds due to lack of nursing and domestic staff, the delay in provision of spectacles due to the unexpectedly large number of persons applying for glasses, and the fact that dental surgeons are leaving the service of local authorities in alarming numbers in order to take advantage of the greatly-enhanced remuneration available in private practice. Whereas the first of these difficulties may be considered to be only indirectly the concern of local health authorities, the last (i.e., the drift of dental surgeons into private practice) will assuredly have a disastrous effect on the dental welfare and health of expectant and nursing mothers and young children lor a generation unless steps are taken forthwith to accord to them that priority of dental inspection and treatment which was envisaged in the new Act. More detailed observations on the new dental arrangements and their effect will be found on pages 71 to 73. Local Administrative Arrangements. It is with Part III of the Act—that dealing with local government services—that Leyton Borough Council, as the Maternity and Child Welfare Authority before the appointed day, has the most direct concern. On 5th July it handed over to the new Welfare Authority (Essex County Council) its former responsibilities in respect of midwifery, maternal and child welfare, dental service for exp ctant and nursing mothers and children under five, domestic help, day nurseries, health visiting, care and after-care, immunisation and ambulance service. Such a radical change in the administration of these personal health services naturally caused a certain amount of administrative difficulty and dislocation; and there is no doubt that during the first six months of the new 'set-up' the administrative staff have been severely taxed in their efforts to deal with the great increase in clerical work and correspondence. Other difficulties, those inherent in any system of remote control, have arisen. Whether these are merely teething troubles, or whether they will become permanent features of the new administrative arrangements, time alone will tell. 62 SECTION 21 HEALTH CENTRES. Report by the Medical Officer of Health, October, 1948, on the Former Relief Office Premises, 135, Dawlish Road, E.10. Reference. The County Council has agreed that the above property should be allocated for health purposes, and I have been asked to submit my recommendations for the possible use of the premises as a Health Centre. Policy. The policy of Leyton Corporation was that contained in Council Minutes 3407 and 3408 of October, 1946—that provision be made for the establishment of one new main health centre and six subsidiary centres, and that consultant and specialist services be provided only in the main centre. It is the intention of the Town Planning Authority that health centres should be established in Neighbourhood Centres. Existing Health Centre Facilities. The two existing health centres in the Borough—at Leyton Green and Park House—were specially built for the purpose in 1933 and 1935 respectively. Each provides accommodation for the combined medical, dental and nursing services of the Health and Education Authorities. Specialist clinics are provided as follows :— Leyton Green—Ophthalmic; orthoptic and orthopaedic. Park House—Ear, nose and throat. Whereas these two centres were considered to be models at the time they were built, the great expansion in the scope of health services since that time has been such that they can no longer be considered adequate—in fact they are now seriously overcrowded. The establishment of an additional health centre would undoubtedly relieve the overcrowding and congestion at the two existing centres. The former Relief Office buildings in Dawlish Road are situated near the centre of that densely-populated part of the Borough containing the Wards known as Central North and Central South, with a combined population—according to the last official census returns—of some 22,414 persons. At the present time mothers and children in these Wards have no easily-accessible health centre, and a centre at Dawlish Road would meet that difficulty. 63 Site and Buildings in Dawlish Road. The buildings were erected by West Ham Board of Guardians as a Relief Office and dwelling-house in 1925. The site covers an area of 2,253 sq. yds. On the eastern aspect there is a vacant piece of ground—now set out in allotments—with a road frontage in Dawlish Road of 75 ft. and an area of 7,650 sq. ft. In the middle of the site is the main building, erected as a Relief Office and used as such until 5th July last, since when it has not been in use except once a week for dancing. The road frontage of this building is 84 ft. To the west of the main building, and separated from it by a paved passage-way 6 ft. wide, is a large detached two-storey house at present occupied by a former Relieving Officer. The house has a road frontage of 36 ft. Accommodation. Main Building. (a) A large Central Waiting Hall, measuring 72 ft. by 32 ft. (b) Seven rooms—of which one is used by the non-resident caretaker—leading off the Central Hall. These rooms have a uniform width of 13 ft. (c) More than adequate water closet accommodation for public and staff. (d) Store cupboard and telephone room. (e) Underground boiler house. Dwelling-House. Ground floor—large sitting room, living room, kitchen and scullery. First floor—three bedrooms (one double) and bathroom. suitabiilty or premises. The Special Committee appointed to consider the functions and design of health centres to be provided under the National Health Service Act, 1946 were unanimous in recommending that health centres should be in new buildings specially designed for the purpose, and undoubtedly that recommendation is sound. Any adaptation of an existing building is relatively unsatisfactory, and may be considered to be at best a makeshift arrangement. Unfortunately it may be a long time before such new ad hoc buildings are available, but the Relief Office Building in Dawlish Road has the great advantage that it could be made available for use in the near future. 64 The main building is structurally sound. The floors, of wooden blocks, are in good condition throughout, and the walls, except in the room formerly used as a Committee Room, are tiled to a height of 5 ft. with dismal, dark-brown coloured tiles. Internally the premises have the inhospitable and severe "institutional" appearance and atmosphere characteristic of barracks and Board of Guardians' institutions of the time and they lack many desirable features and amenities we expect to find in modern health centres. Although the main building is large, so much of the accommodation is devoted to the large central waiting hall that the accommodation available for actual clinic purposes is relatively small. On each side of the hall there are three rooms available for clinics, but none is sufficiently large to justify it being considered ideal as a room to serve either as a school minor-ailment clinic or as a weighing room for infants and toddlers. With regard to situation, the premises have the great advantage that they are so easily accessible to such a large and densely-populated area of the Borough. On the other hand, they are more than 400 yards from the nearest 'bus route and could not be considered suitable for the establishment of a main health centre with specialist clinics to serve the whole Borough. Notwithstanding these deficiencies, I consider that the building can be adapted to provide accommodation for a subsidiary health centre as adequate as could be expected in any building not specially designed for the purpose. The adjoining house is well-built and in good condition and could be used to provide residential accommodation for members of the staff until such time as the housing situation becomes less acute. The large vacant piece of ground* to the east of the main building could be used to provide accommodation for future extensions of health services. I am of opinion that the main building could more easily and at less cost be adapted as a health centre for use by local medical practitioners under the provisions of Part IV of the National Health Service Act, 1946; but I am informed that the County Council do not propose to consider its allocation for that purpose at present. Under the circumstances I suggest that it should be adapted for use as a subsidiary health centre to accommodate the combined health services of the Health and Education Authorities. 65 Services to be Accommodated. A subsidiary health centre should accommodate at least the routine medical, dental and nursing services connected with the County Council's arrangements for the supervision and care of pre-school and school children, expectant and nursing mothers. Such accommodation should include rooms for School medical service— (1) Minor ailments clinic. (2) Doctor's consulting room. Child welfare service— (3) Weighing room. (4) Doctor's consulting room. Dental— (5) Dental surgery. (6) Dental recovery room. General— (7) Store room. (8) Dispensary and clinical testing room. (9) Clerk's room. (10) Stalf room. It is clear that the existing six rooms cannot provide the accommodation outlined in the above list. I have therefore conferred with the Borough Surveyor, who is preparing plans and estimate of structural alterations which will be necessary to provide the minimum accommodation. Recommendations. 1. That arrangements be made for the establishment of a Subsidiary Health Centre in the premises at 135, Dawlish Road, Leyton, which were used by the Public Assistance Committee as a Relief Station prior to 5th July, 1948. 2. That the adjoining house be used to provide residential accommodation for members of the staff of the health department. 3. That the health centre provide the necessary facilities in connection with the medical, dental and nursing services of the Health and Education Authorities to serve the area of the Borough comprising Central North and Central South Wards. 4. That authority be given for the structural and decorative work necessary to adapt the premises for these purposes, and for the purchase of the necessary furniture and equipment. 66 SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN. Births. 1,810 births were registered during the year:— Males. Females. Total. Legitimate 921 840 1,761 Illegitimate 25 24 49 946 864 1,810 The birth rate per 1,000 of the population was thus 17.06. 1,797 notifications of births were received during the year:— Prom medical practitioners 289 From midwives 1,508 Ante-Natal Clinics. In October, 1948 there was established at the Essex Nurses' Training Home, Beachcroft Road, E.ll an additional ante-natal clinic to serve the large proportion of expectant mothers in that part of the Borough who engage Essex Nurses' Training Home midwives for their confinements. The establishment of this clinic promotes closer liaison and co-operation between the Authority's medical staff and the midwives who have been engaged for domiciliary confinement, and mothers living in the area appreciate the opportunity of having their ante-natal supervision conducted " on the spot ". Beachcroft Road Home is now equipped with modern accommodation and facilities for ante-natal supervision. Attendances— First Attendances. Subsequent Attendances. Total. 545 713 1,258 The average number in attendance at the Ante-Natal Clinics held at the Council's three Centres during 1948 was 11.75 per session. The number of home visits made by health visitors to expectant mothers during the year was 40. 67 Maternity Bed Accommodation. In the past Leyton Corporation has had arrangements with Queen Mary's Hospital, Stratford, and with the Mothers' Hospital, lapton, for the provision of maternity beds for Leyton mothers. From time to time the Leyton Maternity and Child Welfare Authority has considered the possibility of providing a Maternity Home in the Borough, but the declared policy of the Ministry of Health is that it is undesirable to provide small maternity homes as separate units, and that new maternity bed accommodation should be associated with general hospitals on grounds of efficiency as well as to facilitate specialist treatment of non-obstetric conditions associated with pregnancy and childbirth. In Leytonstone No. 10 Hospital Group area there is no provision for maternity beds, and I suggest that a Hospital Group without such provision cannot be regarded as an effective unit; and it would be interesting to learn whether there is any other Hospital Group in the country without provision for institutional midwifery. Situated as it is in the Leytonstone No. 10 Hospital Group area, Whipps Cross Hospital would be an ideal place for the establishment of a maternity unit. If maternity accommodation and staff were provided there, it would be possible to institute a most desirable co-ordination of hospital and health centre (ante-natal clinic) premises, staff and facilities in this area. Such a co-ordinated arrangement would ensure that the doctors responsible for the ante-natal supervision of expectant mothers would be those who would be responsible for their subsequent confinement in hospital. The local health authority has two well-equipped ante-natal clinics where members of the medical staff of the obstetric unit could conduct the ante-natal supervision of Leyton expectant mothers ; and it is generally agreed that such joint use of clinic premises would overcome many present difficulties and further the establishment of a co-ordinated hospital and health centre system. Child Welfare Clinics. On page 66 will be found a Table giving detailed information regarding the attendances of infants and children at the 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 17,915 in 1946 to 21,389 in 1948—an increase of 20 per cent. 68 ATTENDANCES, EXAMINATIONS, etc., 1946—1948. Leyton Green Park House All Centres 1946 1947 1948 1946 1947 1948 1946 1947 1948 Under 1 year—- 1st attendances 826 896 705 682 877 682 1508 1773 1387 Subsequent attendances 6885 8967 7806 5930 8332 7601 12815 17299 15407 Total attendances 7711 9863 8511 6612 9209 8283 14323 19072 16794 1-5 years— 1st attendances 76 82 94 75 78 81 151 160 175 Subsequent attendances 1587 1552 1997 1854 1781 2423 3441 3333 4420 Total attendances 1663 1634 2091 1929 1859 2504 3592 3493 4595 Total attendances, both age groups 9374 11497 10602 8541 11068 10787 17915 22565 21389 Average attendance per session 62.79 76.64 70.21 57.32 73.78 69.59 59.71 75.21 69.89 Number examined by clinic doctor 2237 3029 2999 2201 3092 3350 4438 6121 6349 Number weighed 9368 11493 10597 8539 11065 10787 17907 22558 21384 69 Post-Natal and Gynaecological Clinic. Leyton Green Health Centre. Number of Sessions 18 Letters of Invitation 274 First Attendances 156 Re-attendances 141 During the year 18 sessions of the Post-Natal and Gynaecological Clinic were held. The number of new patients who attended was 158, out of 274 who received appointments to attend (56 per cent.). Of these, 116 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 71 Re-attended for examination and treatment 87 The total number of attendances was 297. The average attendance per session was 16.5—with a maximum of 22 and a minimum of 10. Free medical prescriptions were issued in 95 cases ; and 4 prescriptions were issued for payment by the patients. The following are the main conditions which have been found on examination:— Subinvolution of the uterus 9 Cystocele and rectocele 1 Retroversion of uterus 21 Anaemia 3 Defective perineum 1 Vaginitis 3 Fibroid 1 Birth control 47 Ovarian cyst 4 70 Care of Premature Infants (Circular 20/44). Number of babies notified during 1943 whose mot hers are normally resident in the Borough 117 (a) The total number of premature babies as above who were born at: Home 42 117 Hospital 75 (b) The number of those born at home who: (i) were nursed entirely at home 41 (ii) died during the first 24 hours 1 ,, „ 1 to 7 days 1 (iii) survived at the end of one month 40 (c) The number of those born in hospital who: (i) died within the first 24 hours 5 „ ,, 1 to 7 days 3 (ii) survived at the end of one month 67 Issue of Vitamin Products. The following figures issued by the Ministry of Food show the average weekly issue of vitamin products during the year 1948. Orange Juice. Cod Liver Oil. A and D Tablets. Bottles. Per cent Bottles. Per cent. Packets. Per cent. Leyton 2,959 57.88 743 48.20 188 58.76 Divisional Total 194,563 50.29 46,591 40.83 11,691 42.57 Puerperal Pyrexia. Ten cases of puerperal pyrexia were notified during the year. Obstetric Consultant. The advice of the Council's Consultant Obstetrician was not sought during the year. Maternity Mortality. There were 3 maternal deaths of Leyton residents during the year. 71 Dental Treatment. On pages 102 to 104 will be found the report of the Senior Dental Surgeon (Mr. A. E. Hall) on the work of the local dental service during last year. Considering the difficulties with which he has had to contend—war damage repairs of premises and extreme shortage of staff—during the year, I consider that his record of work done in these trying circumstances is most commendable. With regard to staff, the agreed number of dental surgeons considered to be necessary in Leyton for the school dental service alone is six ; but during the year under review the only full-time member of the staff has been the Senior Dental Surgeon, and it has been necessary to supplement the staff by engaging such temporary part-time assistance as happens to be available on a sessional basis. The engagement of such sporadic temporary part-time medical or dental assistance on a sessional basis is unsatisfactory, uneconomic, and unfair to both patients and staff. Unless a dental surgeon can follow-up his cases, he is deprived of one of the greatest incentives to interest and pride in his work; and mothers and children are entitled to expect that they should not be inspected or treated by a different dentist every time they make an attendance. I regard continuity of inspection and treatment as of prime importance in any public medical or dental service; and for that reason I beg that serious consideration be given to the present position in which mothers and children are now placed in consequence of the new dental arrangements set up under the new National Health Service Act. In framing the National Health Service Act, 1946—which came into operation on 5th July, 1948—the Government policy was that :— "Until the supply (of dentists) can be increased, attention will have to be concentrated on priority needs. These must include the needs of children and of young people, and of expectant and nursing mothers." Ministry of Health Circular 118/47 of July, 1947, dealing with the Health Services to be provided by Local Health Authorities under Part III of the Act, stresses that:— "The intention of Section 22 is clearly to put them (expectant and nursing mothers and young children) in a preferential position and to afford them some guarantee of treatment not given to other classes. Local Health Authorities cannot give effect to this intention without expanding 72 stantially the provision now made by Welfare Authorities as part of their Maternity and Child Welfare Services, and putting more emphasis on conservative treatment." Again, the Report of the Inter-Departmental Committee on Dentistry (the "Teviot" Committee), set up by the two Health Ministers, contains the following observations:— "There are certain classes of the community who stand particularly in need of dental care and who can benefit in a special way from it. Steps must be taken to see that that care is made available to them and also that, so far as education and persuasion can go, they accept it. " We have received a great deal of evidence in favour of a concentration of effort on the dental care of (a) expectant and nursing mothers; (b) children, and (c) adolescents. There are already, as we have shown, public services organised by local authorities which go some way towards meeting the needs of these classes, namely the school dental service and the dental arrangements made by maternity and child welfare authorities. Our concern is not to dispense with these services, nor to regard a general service as a substitute for them, but rather to strengthen and improve them by all practicable means; they must form, as it were, the sharpest point of attack of the dental force of the country upon dental disease. "The claims of these classes need hardly be argued. In the case of the expectant and nursing mother, the harm that oral disease can cause both to mother and child is well known. As regards the young it is not only that their health and development benefit in a special degree from dental care; a point ultimately of even greater significance is that if they come to a true valuation of dental health, our major problem is solved not only for them in their adult lives, but also for future generations." Unfortunately these precepts are, and will be for some considerable time, impossible to put into practice due to the great shortage of dental surgeons throughout the country and the fact that dental surgeons are leaving the service of local authorities in large and alarming numbers in order to take advantage of the greatly-enhanced remuneration available in private practice since 'the appointed day'. If mothers and children showed willingness to attend private dental surgeons for conservative dentistry (fillings, etc.), the new dental arrangements under the provisions of the National Health Service Act could be regarded as, in any case, a substitute for the 73 local authority dental services; but the evidence so far available in this area is that they are continuing to rely on the local authority dental surgeons for inspection and treatment. Even in the Grammar Schools, where one would expect the highest proportion of pupils to have their own private dental practitioners, the number was only 1 per cent, in the case of boys and 3 per cent, among girls. An additional feature of the new dental 'set-up' is that whereas a few mothers have taken their children to private dentists to have teeth extracted, they do not attend there for regular inspection and fillings. The loss in a young child of unsaveable teeth by extraction is unnecessary mutilation which can and should be avoided, and the only method I know of avoiding it is by the regular dental inspection and treatment of all children—at least every six months —from two years of age until they leave school. The attainment of that ideal requires first of all an adequate dental staff. It also requires much individual persuasion and tact on the part of the available staff who conduct the routine inspections. Under the circumstances, I cannot regard the new dental arrangements, and the alarming drift of local authority dental surgeons into private practice, as other than a disaster as far as expectant and nursing mothers and school children are concerned. It is clear that the Government was fully alive to the exceptional needs of mothers and children when the Act was framed, and it is unfortunate that the great disparity in the subsequent remuneration of public and private dental surgeons has been instrumental in frustrating the Government's declared intention. Unless something is done at once to remove this anomaly, the harm which will be done to the dental welfare of expectant and nursing mothers and young children will have widespread and far-reaching effects on their future health. Report of Senior Dental Surgeon. (A. E. Hall, L.D.S.) All expectant or nursing mothers and pre-school children referred for dental treatment by the Council's Medical Officers have been treated during the year. There has been a falling-off in the number of dentures supplied to the mothers through the Council's scheme, as some of these patients have consulted private dentists for their artificial dentures following the completion of the necessary extractions. 74 Expectant Mothers. Nursing Mothers. Infants under 5 Years. Patients examined 114 4 334 ,, needing treatment 114 4 334 ,, treated 114 4 334 ,, made dentally fit (complete treatment) 96 2 309 Attendances 307 10 492 Extractions 414 8 407 Fillings 74 10 178 Other dental operations 74 — 119 Scalings 70 4 — Anaesthetics:— General 97 — 175 Local 52 8 23 No. of Dentures supplied:— (1) Full 7 (2) Partial 7 Orthopaedic Treatment. Primary Examinations.—During the year 28 children were referred from the Child Welfare Clinics to the Council's Orthopaedic Surgeon. Re-examinations.—In addition to the 28 new cases mentioned above, 56 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—Fifty-five children made 402 attendances for special treatment by the Council's Physiotherapist. Provision of Surgical Appliances.—Seventy-two 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. Special Eye Clinic. The Consultant Ophthalmic Surgeon had referred by the Clinic Medical Officers 124 pre¬school children, who made 151 attendances for examination and treatment. 75 Artificial Sunlight Treatment. Number of cases treated 53 Total number of attendances 623 Convalescent Home Treatment. Prior to 5th July last the Maternity and Child Welfare Authority and the Education Authority accepted responsibility for the provision of Convalescent Home treatment in respect of pre¬school and school children, whose parents were assessed to contribute to the cost of treatment in accordance with their means. In future these arrangements will apply only to children who do not require either medical or nursing supervision and treatment. If such medical or nursing supervision is required in respect of a child recommended for convalescent home treatment, the responsible authority will now be the Regional Hospital Board. Application for any future cases which may arise must be made to the Secretary of the local Hospital Management Committee, who will arrange for them to be dealt with by the Almoner of a suitable hospital in the group. The Local Health Authority will no longer be expected to assume financial responsibility for cases referred to the Regional Hospital Board. 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 2 mothers and their babies to have periods of convalescence following confinement. Ophthalmia Neonatorum. No. of Cases Notified. Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hosp. 3 3 — 3 — — — 76 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. 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 2 .14 53 23.24 1947 2,359 78 45 33.06 19.07 42 17.49 1948 1,810 38 22 20.99 12.15 27 14.69 Day Nurseries. Categories of Children Admitted. The selection of children for admission to the two Day Nurseries (Knotts Green and Ellingham Road) in the Borough is in accordance with the following resolutions passed by Leyton Corporation while acting as the local Maternity and Child Welfare Authority:— 1. Council Minute 1179—March, 1946. RESOLVED That, during the period of transition from war to normal peace-time conditions, preference be given to the children of: (i) Employed unmarried mothers who wish to keep their babies with them when not at work; (ii) Employed widows; (iii) Mothers employed in industries vital to production for essential home needs and for export; and (iv) Mothers who are ill or being confined. 2. Council Minute 2509—July, 1946. Further to Minute No. 2204, June, 1946, the Medical Officer of Health reported with regard to the circumstances of children already attending the Day Nurseries and of those on the waiting lists and requested the Committee's instructions regarding (a) the category to which the following types of mothers should be allocated, viz.: (i) divorced from; (ii) separated from; (iii) deserted by their husbands; and (iv) those who have children of whom their husbands are not the fathers; and (b) the category in which motherless children should be placed. 77 RESOLVED (a) That the mothers referred to in (i), (ii), (iii) and (iv) be placed in category 2 of the Council's scheme of admission to the Nurseries, subject to a minimum qualifying period of twelve months' residence in the Borough ; and (b) That motherless children be placed in category 1. Number of Children in Attendance and Awaiting Admission. The following list shows the numbers of children in each category (a) in attendance at, and (6) awaiting admission to, each of the two nurseries at the end of December, 1948. Category. Knotts Green. Ellingham Road. (a) In attendance. (b) Awaiting admission. (a) In attendance. (b) Awaiting admission. 1. a Employed unmarried mothers who wish to keep their children with them when not at work 11 4 7 - 1. b Motherless children ... ... ... ... 2. a Employed widows 4 2 5 1 2. b Divorced from husbands 2 ... ... ... 2. c Separated from husbands 14 5 8 2 2. d Deserted by husbands 4 3 — — 2. e Those who have children of whom the husband is not the father 2 - - - 3. Mothers employed in industries vital to production for essential home needs and for export 18 57 39 119 4. Mothers who are ill or being confined — — — — 55 71 59 122 78 SECTION 23 MIDWIFERY Record of Cases attended by Council Midwives, 1948. Midwives employed by Essex County Council. Attached to the Essex Nurses' Training Home, Beachcroft Road. Total. Cases attended:— (a) As Midwives 160 397 557 (6) As Maternity Nurses 7 77 84 Ante-natal Visits 512 2,694 3,206 Ante-natal Examination 1,388 3,267 4,645 Post-natal Visits 2,855 10,045 12,900 Administrations of Gas and Air Analgesia 10 194 204 Administration of Gas and Air Analgesia. In July, 1945 (Council Minute 2392) Leyton Maternity and Child Welfare Authority agreed to the training of Municipal Midwives in the administration of gas and air analgesia and to the purchase of the necessary apparatus. Since that time all midwives of the Essex County Training Home, Beachcroft Road, have attended courses of training and obtained the necessary certificates. Training in gas and analgesia has since become a necessary part of the training for Part II of the certificate of the Central Midwive's Board. Of the Council's three Municipal Midwives directly employed one is not in possession of the necessary certificate for administration of gas and air analgesia. The following list shows the number of domiciliary confinements attended by midwives (not including cases attended as maternity nurses) during the year and the number of such cases to whom gas and air analgesia was administered:— Cases attended as Midwives 557 Number of administrations of gas and air analgesia 204 Percentage of administrations 36.6 79 Medical Aid. In accordance with the Rules of the Central Midwives' Board a midwife must notify the Local Supervising Authority forthwith on every occasion in which she sends for medical aid. Two hundred and sixteen such notifications were received. Fees paid to Doctors. One hundred and eighty 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 £380 9s. 6d. SECTION 24 HEALTH VISITING. Health Visitors. During the year the Health Visitors have made 10,923 visits to homes, as follows:— (a) To expectant mothers:— First visits 40 Total visits 40 (b) To children under 1 year of age:— First visits 1,860 Total visits 5,790 (c) To children between the ages of 1 and 5 years:— Total visits 5,093 80 SECTION 25 HOME NURSING. Home Nursing. Prior to 5th July, 1948 all home nursing in the area was undertaken by Essex County Nursing Association, a voluntary organisation subsidised by the County Council. Since that time the responsibility for the provision of home nursing has been that of the County Health Authority, by whom the home-nursing staff are now directly employed. I therefore submit for information the following summary of home nursing in Leyton undertaken by nurses attached to Essex County Nurses' Training Home, Beachcroft Road, E.11, from "the appointed day" until 31st December. In doing so I should like to express my personal appreciation of a public service which has not in the past received a great measure of the public appreciation it has deserved. During my tenure of office in Leyton I have had ample opportunity of seeing the great amount of general nursing help given in Leyton homes by Beachcroft Road nurses and of realising the appreciation of their services by local doctors. This home nursing has been undertaken quietly and efficiently by a nursing staff whose chief reward has been their pride in work well done and their satisfaction in the knowledge that their work has been appreciated. No. of Cases. No. of Visits made. Medical 516 15,933 Surgical 80 3,288 Tuberculosis 11 184 Maternity 229 5,152 Ante-Natal 181 1,386 Post-Natal — 4,945 Out-Patients, Medical 146 711 ,, Surgical 217 674 Miscellaneous — 391 Totals 1,380 32,664 81 SECTION 26 VACCINATION AND IMMUNISATION. Vaccination. Return for period 5th July to 31st December, 1948:— NUMBER OF PERSONS VACCINATED (OR RE-VACCINATED). Age at 31/12/48. Total. Under 1 year. 1—4 years. 5—14 years. 15 years or over. Vaccinated 88 2 3 14 107 Re-Vaccinated 1 — - 9 10 Diphtheria Immunisation. Return for the year 1948:— Age 0-5 years. Age 5-15 years. Total. 1. Number of children who completed the course of immunisation during the year: (a) At Municipal Clinics 1,758 89 1,847 (6) By Private Practitioners (from 5th July) 132 7 139 2. Number of children who were given a secondary or reinforcing injection (i.e., subsequent to complete full course) 406 406 3. (a) Approximate estimated child population at end of year 9,132 11,487 - (6) Percentage of child population considered to be immunised at end of year 58.9 76.7 — 82 The above Return—Section 3 (6)—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 five years. Percentage of School Children Immunised. Entrants Second Age Group Third Age Group No. Exmd. No. Immunised 0/ /o No. Exmd. No. Immunised 0/ /o No. Exmd. No. Immunised % 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 1948 1,200 914 76.1 1,062 879 82.7 1,018 752 73.8 Incidence of Diphtheria Among Protected Persons. During 1948 one Leyton child, who had been immunised previously, was notified to be suffering from diphtheria. The following table gives in summary form the information regarding this case. Age. Sex. Date of Immunisation. Date of Notification. Swab Results T=Throat. N=Nose. E=Ear. Diagnosis. 4 M 1946 5.10.48 N and T— Diphtheria of moderate severity. Incidence and Mortality from Diptheria. Totals of deaths and notifications during the past nine years have been as follows: Year. England and Wales. Leyton. Notified Cases. Deaths. Notified Cases. Deaths. 1940 46,281 2,480 55 — 1941 50,797 2,641 44 1 1942 41,404 1,827 39 — 1943 34,662 1,371 28 1 1944 29,949 934 24 1 1945 25,246 722 43 2 1946 18,283 472 38 1 1947 10,465 244 9 1 1948 8,034 150 5 - 83 Protection Against Whooping Cough. At the May meeting of Leyton Public Health Committee I submitted a special report on protection against whooping cough, and the Council agreed with my suggestion that application should be made to have Leyton included among the areas in which the Medical Research Council is at present conducting a large-scale controlled investigation into the efficacy of various preparations of whooping cough vaccine. The Medical Research Council has now written inviting the Council to co-operate in the investigation, and I submit a summary of the suggested scheme with observations and suggestions thereon. Responsible Authority. Among the services decentralised by Essex County Council as Local Health Authority to Area Sub-Committees under the provisions of the National Health Service Act, 1946 (Part III) are:— Section 22.—Care of children who have not attained the age of five years and are not attending primary schools maintained by a local education authority. Section 24.—Health visiting for the purpose of giving advice as to the care of young children . . . and as to measures necessary to prevent the spread of infection. Section 26.—Vaccination against smallpox, and immunisation against diphtheria. Any local health authority may, with the approval of the Minister, make similar arrangements for vaccination or immunisation against any other disease. Section 28.—Prevention of illness. Under the circumstances the appropriate authority for dealing with arrangements for protection against whooping cough of young children (aged 6 to 18 months) appears to be the Local Health Authority rather than the Local Sanitary Authority. Brief Outline of Scheme. Under the general direction of the Medical Research Council controlled tests with American products are already being undertaken in Oxford, Manchester, Tottenham, Wembley and Edmonton, and a certain type of British product is now being tried out in West Ham. Leyton is now being given the opportunity of cooperating in the investigation to ascertain:— (a) the incidence of whooping cough among protected and unprotected children; 84 (b) the absolute and relative efficacy of three different British products, and (c) the extent to which the protection afforded by these three British products agrees with laboratory tests of their potency. Previous experience has shown certain fallacies in comparing results in inoculated and uninoculated groups of children; and, in order that the investigation will be completely objective, no one actively engaged in the investigation will know which vaccine any individual child received. Preliminary Work—Propaganda. The most effective method of obtaining volunteers is for health visitors to explain the scheme to mothers at welfare centres and during routine visits. Pamphlets explaining the scheme, with detachable consent forms, will be distributed to mothers, and each general medical practitioner in the area will receive a letter explaining the scheme and asking for his co¬operation. Posters will be exhibited in each health centre and day nursery. The need for additional propaganda will depend on the response from the sources mentioned above. After receipt of the consent forms the volunteer children will be divided into the necessary age and sex groups, and mothers will be given letters of appointment, etc. Children Eligible. In the first instance only children aged 6 to 18 months will be accepted, as it is in this age-group that most deaths occur. These children must not have had whooping cough, nor must they have been inoculated against it. If sufficient volunteers do not come forward, the age limit may be raised. Course of Injections. The course consists of three injections with an interval of one month between each. These injections do not interfere with diphtheria immunisation; in fact, there is no reason why the two courses of inoculation should not be carried out at or about the same time. Follow-Up. For a period of two years after inoculation each child who has completed the course of inoculations will be visited monthly by a special health visitor. An agreed percentage of children will be 85 visited within 24 hours of each inoculation in order to obtain information regarding reactions. It will also be necessary for a medical officer to visit the homes of children where whooping cough occurs or is suspected. Additional home visiting will be required over a long period in the case of children who may develop whooping cough. This following-up must be carefully organised and carried out, as it is the most important part of the investigation from which the final analysis of results will be made. In addition to the routine visiting outlined above, quite a considerable amount of home visiting will be required in the rounding-up of defaulters who fail to attend. In order that there may be rehable correlation between clinical and laboratory findings it will be necessary to take series of swabs and samples of blood for special bacteriological examination in selected cases. Personnel. It will be appreciated that a large-scale investigation of this kind involves a great amount of careful clinical, laboratory and clerical work by a team of workers able to conduct careful investigations and keep accurate records. The Medical Research Council will defray the cost of the local staff specially employed on the investigation, and have indicated that they will authorise the employment of a health visitor and a clerk in the first place. The question of extra medical assistance may be considered at a later date. As they are such important members of the team, and will be required to undertake so much of the preliminary work, I recommend that authority be given forthwith for the appointment of one state-registered nurse and one female clerk. Summary of Recommendations. If your Authority wish to accept the invitation of the Medical Research Council to collaborate in the investigation, I recommend : (a) that application be made to the Minister of Health for approval (N.H.S. Act, 1946—Section 26(2) ) ; (b) that the Medical Research Council be informed formally that you are prepared to co-operate in the scheme; (c) that sanction be given for the engagement of the necessary staff as outlined above; 86 (d) that I be authorised to make the necessary arrangements and undertake the preliminary publicity in order that the investigation may be commenced as soon as possible. Action Taken. At their meeting held on 9th September the County Health Committee approved these recommendations, but as Dr. Menzies left the area medical staff in that month, I did not feel justified in putting the new scheme into operation until the shortage of medical staff is made up by the appointment of a new Assistant Medical Officer. Considerable difficulty was experienced in obtaining the services of a state-registered nurse and clerk, and eventually it was necessary to second for duty in connection with the investigation a school nurse (Miss R. M. Edwards, S.R.N.) and the domestic help service case visitor (Mrs. I. Neville), who volunteered to take part in the work. As the result of propaganda by local medical practitioners and by health visitors, over 300 applications had been received before the end of the year. Under the circumstances, as further delay was unjustifiable, the Medical Research Council agreed to defray the expense of engaging the services of a parttime doctor, and arrangements were made for the scheme to be put into operation early in January by holding special clinics alternately at Park House and Leyton Green Health Centres. Unfortunately there is no available suitable accommodation in the Health Department Office for the clerical and administrative work to be carried out. SECTION 27 AMBULANCE SERVICES. The following table gives particulars of the cases transported in the Leyton Council Ambulances during the period 1st January to 4th July, 1948, after which date the ambulance service was taken over in its entirety by the Essex County Council:— Accidents 189 Taken ill in street 81 Maternity 259 Attempted suicide 8 Transfers to and from hospitals 1,884 2,421 The mileage covered during the period was 13,705. 87 SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER-CARE. Foot Clinic. Annual Attendances—1936 to 1948. The Municipal Foot Clinic was opened at High Road Baths, Bakers Arms, in March, 1936, and the following list shows the number of attendances for treatment each year since that time Year. First attendances (new cases). Subsequent attendances. Total attendances. 1936 (from March) 1,281 3,341 4,622 1937 879 5,650 6,529 1938 1,054 7,702 8,756 1939 War years 564 5,617 6,181 1940 387 4,730 5,117 1941 444 4,269 4,713 1942 623 5,841 6,464 1943 484 5,354 5,838 1944 500 5,572 6,072 1946 436 5,599 6,035 1946 822 8,220 9,042 1947 932 9,070 10,002 1948 1,313 11,998 13,311 Staff. In 1936 the staff consisted of the Senior Chiropodist (Mr. J. O'Brien, M.I.S.Ch.) and a Clerk Receptionist. A second full-time chiropodist was appointed in 1937, the third in 1946, and during the year under review (April, 1948) it was found to be necessary to increase the staff to four full-time chiropodists. Public Demand for Facilities. With a well-qualified and experienced staff of skilled chiropodists working in well-equipped premises residents in Leyton have become increasingly "foot conscious" and I consider that the public demand for treatment is likely to outstrip the supply for some time to come. The most disappointing feature connected with the service is the length of time patients have to wait before they can be treated. Effect of National Health Service Act, 1946. When the provisions of the National Health Service Act, 1946 came into operation on 5th July, 1948 there was a certain amount of doubt as to whether municipal foot clinics would be taken over 88 as part of the functions of a Local Health Authority under Sections 22 and 28 of the Act, or whether they would become the responsibility of the Regional Hospital Boards. This question of responsibility had not been finally settled by the Ministry of Health at the end of the year. Pending its settlement, the Local Health Authority has continued to be responsible for foot clinic services in operation on "the appointed day" on the understanding that in the meantime there must be no extension of foot clinic facilities. Removal of Residential Qualification. In consequence of the large number of persons living outside the Borough boundary who had been making use of the foot clinic facilities, in 1943 Leyton Council restricted treatment to residents in Leyton. Since "the appointed day" an increasing number of persons resident outside the Borough have been applying for treatment on the ground that, as the facilities are supplied under the provisions of the National Health Service Act, they are now entitled to such treatment; and in October the facilities became available to residents outside the Borough. Summary of Attendances and Treatment. (a) All Ages. During the year 13,311 attendances for treatment were made, representing an increase of 3,309 over the attendances during the previous year. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 256 2,235 2,491 Females 858 8.609 9,467 Children 199 1,154 1,353 Total 1,313 11,998 13,311 The number of persons who received free treatment was 51 (3.88 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 15 398 413 Females 36 1,705 1,741 Total 61 2,103 2,154 89 Defects Treated. Blisters 1 Bursitis 89 Callosities 340 Corns, hard 192 Corns, soft 28 Corns, under nail 19 Hallux rigidus 23 Hallux valgus 81 Metatarsalgia 48 Nails, club 68 Nails, ingrowing 67 Mycotic infection 13 Pes planus 98 Hyperhidrosis 16 Pernio 1 Verruca pedis 168 Hammer toe 22 Septic conditions 22 Conditions due to sprain 8 Trigger toe 6 Referred for Medical or Surgical Treatment. During the year 25 patients were referred to their own private medical practitioners or hospitals for the following conditions:— Dropsical oedema 2 Removal of cyst 2 Muscular atrophy 2 Verruca pedis 3 Suspected neuroma 2 Excision of nail 1 Phlebitis 2 Hallux valgus (bi-lateral) 2 Pes planus and hallux rigidus 3 Sub-ungual exostosis 1 Fibrositis 4 Dermatitis 1 (b) Children under School Age. Number of children 6 Number of visits made 22 Average number of visits per child 3.6 90 Defects Treated Corn, hard 1 Nail, ingrowing 2 Splinter in foot 1 Verruca pedis 2 (c) School Children. Number of children 193 Number of visits made 1,131 Average number of visits per child 5.8 Defects Treated Corn, hard 16 Nail, ingrowing 3 Blisters 1 Incipient pes planus 5 Mycotic infection 2 Incipient hallux valgus 5 Sepsis 3 Bursitis 3 Hyperhidrosis 1 Hammer toe 1 Sprain 1 Verruca pedis 152 Defects referred to School Clinics Septic condition 1 Tinea pedis 1 pes planus 1 Convalescence for Adults. In accordance with their proposals under Section 28 of the National Health Service Act, the County Council has made arrangements for convalescent facilities for adults at the Essex Convalescent Home, Clacton-on-Sea. SECTION 29 DOMESTIC HELP. Historical Summary. In 1929, shortly after I took over my duties as Medical Officer of Health in this area, I submitted to the Leyton Maternity and Child Welfare Authority a scheme for the provision of Home Helps during the confinement or incapacity, due to obstetric reasons, of the mothers of households in Leyton. From that time 91 until 1946 the scheme underwent some minor modifications to meet the difficulty in obtaining enough experienced and reliable women who were willing to have their names put on the Council's list of approved Home Helpers, owing to the spasmodic and casual nature of the employment, which was not of the type likely to attract the best type of women. In December, 1944 (Ministry of Health Circular 179/44) the Minister of Health expressed the concern of the Government regarding the need for supplying domestic help to persons sick and infirm, and extended the power of Local Authorities to provide such help in necessitous cases other than mothers and young children. In January, 1945 Leyton Council adopted a scheme to comply with the recommendations contained in Ministry of Health Circular 179/44, but, owing to war-time conditions, no suitable applicants could be referred by the Ministry of Labour and National Service. On 1st October, 1946 Leyton Council, with the co-operation of the Women's Voluntary Service, were able to put into operation a more comprehensive scheme advocated by the Minister of Health —that of supplying Domestic Help to persons sick and infirm, in addition to maternity cases. On that date the Domestic Help Office was opened at 267, High Road, Leyton, with an approved administrative staff of one Clerk and one Case Visitor. The following figures show the number of Domestic Helpers available for duty on the dates shown:— Full-time. Part-time 31st December, 1946 3 10 31st December, 1947 1 18 31st December, 1948 3 29 In December, 1946 the Clerk resigned and the Domestic Help Office was transferred to the Public Health Department. Since that time there have been several changes of Clerk, and the bulk of the clerical and administrative work has fallen on Mr. Softley and the staff of the Public Health Department. Summary of Cases Helped during 1948. The following figures show in brief outline the relevant particulars regarding cases helped during the year:— Maternity. Other. Total. No. of cases dealt with 162 85 247 92 Help supplied: (a) Full-time 149 27 176 (b) Part-time 13 58 71 The following list shows the disabilities from which the 247 applicants were suffering and the number of cases in each category that were helped during the year:— Disability. No. of Cases. Maternity 162 General debility 11 Post-operative debility 9 Arthritis 7 Heart disease 6 Bronchitis 6 Cancer 5 Phlebitis 3 Nervous debility 3 Cerebral haemorrhage 3 Hypertension 3 Anaemia 2 Senile decay 2 Sturgeon Weber's disease 2 Erythema nodosum 2 Debility following confinement 2 Asthma 2 Fracture of leg 2 Ulcerative colitis 1 Appendicectomy 1 Sciatica 1 Breast abscess 1 Cerebral thrombosis 1 Acute mastitis 1 Post¬herpetic neuralgia 1 Thyroneurosis 1 Pleurisy 1 Recurrent jaundice 1 Advanced pregnancy 1 Leg injury 1 Duodenal ulcer 1 Lumbago 1 Pneumonia 1 93 Certain Difficulties in Administration. (a) Selection of Cases for Help. As long as the demand for help is greater than the available supply of helpers, it will be necessary to select cases on grounds of need and urgency. In the past, priority has been given to (maternity cases and to cases of acute illness or emergency, and an endeavour has been made to supply a large number of applicants with a little help rather than a few applicants with much. Difficulties and disappointments are bound to arise under such circumstances. For instance, help may have been promised in a necessitous case, but this arrangement may be upset by a confinement taking place say a month before it is due. The only way to meet the situation is by withdrawing a helper from a chronic case, but the chronic case is aggrieved because he/she has been "let down". Difficulties such as these can generally be dealt with by tactful explanation of the circumstances, and it says much for the operation of the service so far that complaints have been so few. (b) The Chronic Case. Of the cases still being helped, six were receiving help before 5th July last. The disabilities from which these six persons are suffering are: arthritis (3); cancer (2); bronchitis and asthma (1); and unfortunately these disabilities are likely to persist as long as the patients live. Even if hospital accommodation were available, there is no power to enforce removal of these cases to hospital. On humanitarian grounds they require help, but the question is whether it is the duty of the Domestic Help Service to continue such help uninterruptedly for the duration of life. If so, it is only a matter of time before the service becomes overloaded with chronic cases. (c) The Infectious Case. Owing to the lack of sanatorium and hospital accommodation for persons suffering from tuberculosis, applications are now being received for domestic help on behalf of persons suffering from tuberculosis, and such applications are likely to increase as soon as it becomes known that domestic help is available. Here, as in the cases mentioned above, help is indicated on humanitarian grounds, and such help as is given may be required for a very long time; but there are certain legal and administrative aspects requiring consideration. 94 In the case of a person suffering from tuberculosis I am forbidden by the Tuberculosis Regulations from divulging that information to any other person, e.g. the domestic helper. On the other hand, in the event of the helper developing tuberculosis after helping in a tuberculous household, she has no legal claim to compensation. These difficulties can be met by the patient agreeing to the nature of his/her disability being divulged, by the domestic helper volunteering to help with the knowledge of the patient's disability and by the helper taking all necessary precautions in the infected home. (d) The Dirty House. The work for which a domestic helper is engaged is to carry out the ordinary domestic duties usually undertaken by the housewife. It is generally agreed that some 5 per cent. of mothers are feckless and incompetent in their household work, and in a few cases the house is in such a dirty and neglected condition that nothing short of intensive and radical spring-cleaning of the premises and thorough cleansing and disinfestation of the children and disinfection of the premises are needed. Although action can be taken with regard to disinfection of premises and disinfestation of occupants, there is a limit to what a domestic helper should be expected to do in the way of intensive spring-cleaning. Unfortunately it is in dirty houses of this kind that the householders are inclined to make unreasonable complaints regarding the failure of helpers to keep the premises clean, and I do not consider that I am justified in requiring a helper to undertake work in households which are unreasonably dirty. Domestic Help Organiser. I am informed that it is the intention of the County Council (hat there will be a "County Organiser of Domestic Helps" at Chelmsford and a "Domestic Help Organiser" in each of the Health Areas. Of the eleven Health Areas in the County seven have already appointed (or approved the appointment of) Organisers, and I recommend that consideration be given to the advisability of making a similar appointment in Leyton Area. Duties of an Area Domestic Help Organiser. (1) To work under the direction of the Area Medical Officer in establishing, maintaining and supervising an efficient body of domestic helps. 95 (2) To deal with applications from: (a) Applicants wishing to become Domestic Helps (b) Applicants requiring the services of a Domestic Help. (3) To allot Domestic Helps to patients and to give accurate and detailed instructions to the Help with regard to each case. (4) To arrange holidays and relief duties of Domestic Helps and generally to look after their welfare. (5) To keep such records as the Area Medical Officer deems essential for the smooth running of the service and make such returns as the Area Medical Officer requires. (6) To maintain contact with Health Visitors, Midwives and Home Nurses in the area and to work in co-operation with them. (7) To pay such visits to the homes of patients as may be necessary, always bearing in mind that Health Visitors, Midwives and Home Nurses may be able to give information regarding cases. (8) To take the necessary steps to make known in the area, requirements of the service and the best ways of meeting it. It will be appreciated that these are very responsible duties on which much of the success of the service will depend. The Organiser should be a woman with experience of dealing with the public, of pleasing and understanding personality, sympathetic in her dealings with persons in genuine need and tactful in dealing with applicants not requiring help. She will have to assess the amount of help required, and to ensure that the services of helpers are used to the best advantage. Without being too much of a disciplinarian, she should command the confidence and respect of helpers, midwives, nurses and local medical practitioners. For these reasons it will be appreciated that the remuneration should be such as to attract the right type of applicant. Full-Time or Part-Time Domestic Helps. In the County Council's proposals made under Section 29 of the National Health Service Act it was indicated that it was proposed, as opportunity offered, to recruit and employ at least 100 full-time and 400 part-time Domestic Helps in the 96 tive County, although it was realised that this would probably be found to be an under¬estimate of requirements. In the Leyton Area three Helps have been officially appointed full-time and, of the 29 part-time Helps 17 have indicated their willingness to work full-time. For Superannuation purposes Domestic Helps are classed as "Servants". Full-time Helps enjoy certain privileges to which part-time Helps are not entitled—Superannuation and Sick Pay A part-time Help who is giving full time to her duties is therefore at a disadvantage. On the other hand, it will be appreciated that the demand for Domestic Helps varies widely from week to week, and that it is not always easy to arrange for the full-time employment of Helps. From an administrative point of view it is found that the employment of part-time Helps is easier and more economic. When full-time Helps are appointed, they are given to understand that their services may be required in connection with the work of Health Centres and Day Nurseries when not required for domestic help, but my experience has been that such alternative arrangements are not of much avail in actual practice. It is generally found that when Health Centres and Day Nurseries are very busy so are Home Helps. School Medical Service 98 The figures set out below relate to the calendar year ended 1948. Number Roll Average Attendance Percentage of Attendance 1. Secondary Schools 8 4,420 4,401 90.52 2. Primary Schools 18 7,417 6,511 87.78 Totals 26 11,837 10,912 88.81 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 1,200 Second Age Group 1,062 Third Age Group 1,018 Total 3,280 Of 3,280 children who were examined in the code age-groups, 2,595 (or over 78 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 4,639 comparing with 3,901 during the previous year. Re-inspections. The number of re-inspections during 1948 was 8,458. 99 The Findings of Medical Inspection. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups— Entrants 1,200 212 17.6 Second Age Group 1,062 151 14.2 Third Age Group 1,018 124 12.1 Total (Code Groups) 3,280 487 14.8 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 853 children were found to be unclean out of a total number of 28,422 examined (i.e., 3.0 per cent.) Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 1.633 20 5 Capworth Street 2,002 60 10 Cann Hall Road 1,780 14 10 Church Road 2,077 39 6 Cobbold Road 72 2 Connaught Road 1,716 39 24 Downsell Road 2,041 38 25 Da vies Lane 2,293 49 19 Farmer Road 1,495 30 2 Goodall Road 1,635 54 11 Kirkdate Road 257 Lea Bridge Road 170 3 Mayville Road 2,121 117 44 Norlington Road 1,670 16 7 Newport Road 2,870 82 21 Sybourn Street 2.145 20 4 St. Joseph's 310 20 Trumpington Road 1,219 24 5 Knotts Green and Harrow Green 365 24 1 Leyton County High School 551 8 — Total 28,422 659 194 Number of individual children found unclean 853 of whom 194 were referred to the Minor Ailments Clinics. 100 The incidence of uncleanliness for the past 10 years is shown in the following table. Year Number of Examinations Number Cautioned Number Excluded 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 1948 28,422 659 194 194,373 7,575 1,826 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 3,115 children attended the clinics, and 13,830 attendances were registered. Defective Vision.—Of the 3,280 children subjected to routine code group inspection in the schools, 156 (4.7 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 815 children. They made 1,087 attendances for examination and treatment. Orthoptic Clinic. 1. Number of sessions held 178 2. Number of cases investigated 331 3. Number of cases treated 146 4. Number of cases refused 5. Number cured : Complete (a) Without operation 37 (b) With operation 6 (c) Total 43 Cosmetic only. - 3 101 (d) Number of cases of Amblyopia included in above total cured 30 6. Number still under Treatment 93 7.. Number failing to attend for complete course 6 8. Discharged unsuccessful 4 9. Number on waiting list — 10. Number of cured cases relapsing and requiring further treatment during : First Year following discharge Nil Second „ ,, „ Nil Third „ „ „ Nil 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 682 S27 196 102 221 74.16 Cann Hall Capworth 223 465 89 201 201 69.31 Church 189 425 77 163 196 81.66 Connaught ... ... ... ... ... ... Da vies Lane 503 259 . 227 115 247 72.2 Downsell 410 402 109 140 191 64.09 Farmer 545 212 104 50.0 Goodall ... ... ... ... ... ... Harrow Green 47 33 22 15 23 62.1 Kirkdale ... ... ... ... ... ... Knotts Green 33 25 16 12 22 78.5 Lea Bridge 41 38 15 17 24 75.0 May ville 255 375 121 158 184 65.9 Newport 444 404 159 123 233 82.6 Norlington 267 546 89 229 184 42.1 Sybourn ... St. Joseph's 47 42 23 27 24 48.0 Tom Hood Trumpington 218 197 90 100 133 70.0 County High 495 470 244 243 326 66.9 Report by the Authority's Senior Dental Officer (A. E. Hall, L.D.S.) 102 Report by the Authority's Senior Dental Officer, 1948. General. The outstanding difficulty of the year under review has been the continued inability to secure full-time dental officers to complete the Authority's authorised establishment of six full-time dentists, and it has been necessary to accept whatever assistance has been forthcoming from part-time private practitioners. By this means there has been for part of the year a maximum equivalent of 23/11ths dental officers working in the area. In September, however, one of these private practitioners found it necessary to reduce his sessions of work by two per week and this, together with the fact that private practitioners will not attend on Saturday mornings and on various odd sessions according to their own private arrangements, has lowered the average attendance to an equivalent of two full-time dental officers to do all the work necessary for 12,000 school children, expectant and nursing mothers, and pre-school children in addition. During 1948 the war damage repairs were completed at Park House Health Centre and two dental surgeries were re-opened there on 23rd March. It has not been found possible to staff one of these surgeries more than 4/llths of its time. From 6th May until 25th June, 1948 the dental services provided from Leyton Green Health Centre were carried on at Knotts Green Open Air School, due to war damage repairs at the Health Centre. It is, as yet, somewhat early to assess the effect of the private practitioners' services being available to our patients under the general dental service established since July, 1948 ; but a general survey leads one to the belief that it has not had much effect since some children are brought to the Health Centres whose mothers say they have endeavoured to obtain treatment privately but have been referred to the Health Centre or offered an appointment three weeks ahead. Where treatment has been carried out for some of these children by a private practitioner it usually appears to have been the extraction of an aching tooth. The fact that school children may be treated by a private practitioner does not, in some ways, appear to be a good thing, as in the past persuasion was always used to get the conservative or filling work done, and in many cases it was completed before the extractions were commenced ; whereas in the private practitioner service persuasion to attend for multiple fillings does not appear to be the custom. 103 An examination of all children attending the County Secondary Grammar Schools in the area in December, 1948 revealed that out of a total of 965 children seen 3 per cent, among the girls and 1 per cent, among the boys claimed to be the patients of private practitioners. It would seem, therefore, that treatment of school children in the Health Centres established by Local Authorities must continue to be the main method whereby their dental needs will be met, and it must, therefore, be a matter of urgent public importance that steps be taken to build up these services and rescue them from the moribund condition in which they now find themselves due, in part, to the fact that no recruits are forthcoming, while at the same time large numbers of public dental officers are leaving the service for private practice. Routine Inspection. Dental inspection has been carried out in all but five schools in the area during 1948, but a recommendation of the Ministry of Education (Circular 1523, 1940) has been implemented and only those children whose parents regularly accept the offer of conservative dental treatment have been sent for and given complete treatment. Any children with pain have, of course, been treated ; and any seeking advice have received it. Anomalies in the figures, relating to the percentage of acceptances in some cases, is due to the re-organisation of the schools in August, 1948 between the time of inspection and the giving of treatment in Norlington in July, and Newport in September. For example, Norlington School shows an acceptance rate of only 42.1 per cent., compared with 73.9 per cent, in the previous year. Many of these children who had been inspected in July were transferred to Newport, Connaught and other schools, and not having returned acceptance forms, were re-inspected at the new schools and included with the acceptors from those schools. Routine Treatment. Conservation by filling of as many temporary teeth as possible up to about 8 or 9 years of age, followed, wherever possible, by filling of all saveable permanent teeth, is the aim of the service so that children leave school trained in the care of the teeth and without the loss of permanent teeth. 104 Orthodontics. As much of this work as was considered justifiable in view of the depleted dental staff was carried out during the year and mainly by extraction and/or the fitting of a removable appliance. Routine X-rays of these cases were not taken at the commencement of treatment as we do not possess this facility at the Health Centres, and only those cases where it was considered quite indispensable were sent to one of the teaching dental schools for this purpose. Analysis of Orthodontic. Cases, 1948. Impressions taken 144 Study and progress models made 144 Appliances fitted 65 Alterations and repairs 13 Attendances 664 Advice 165 Adjustments to appliances 427 Cases sent to hospital for X-ray 6 Teeth extracted for orthodontic reasons : Temporary 488 Permanent 118 Prosthetics. Full upper and lower dentures were supplied to one child in a case of gross and rapid dental decay. Thirteen children had dentures carrying from one to four teeth. Several of these were following accidents involving the loss of one or two upper front teeth, and were of the nature of space-retainers which may be followed by a permanent denture or, if conditions prove satisfactory on completion of jaw growth, a small bridge. Maternity and Child Welfare. All expectant and nursing mothers and pre-school children referred for dental treatment by the Council's Medical Officers have been treated during the year. There has been a falling-off in the number of dentures supplied to the mothers through the Council's scheme, as some of these patients have consulted private dentists for their artificial dentures following the completion of the necessary extractions, instead of through the Council's scheme. A summary of work done under this heading will be found in the Maternity and Child Welfare section of the Health Report. 105 Orthopaedic Clinic. The following is a summary of the work of the orthopa die clinic during the year :— Examinations. Primary examinations 59 Re-examinations 193 Treatment. Number of children who attended for 322 Attendances made 1,672 The findings at the primary examination were Deformities—Bones and Joints. (a) Congenital— Sprengel's shoulder 1 Talipes equino varus 8 „ calcaneo valgus 1 Dislocated hip 1 (b) Acquired— Pes piano valgus 43 „ planus 40 Genu valgum 8 Hallux valgus 17 ,, rigidus 1 Varus digits 6 Pes cavus 3 Hammer toe 2 Muscular. (a) Congenital— Torticollis 5 Scoliosis 3 (b) Acquired— Torticollis 5 Scoliosis 4 Kyphosis 14 Poor posture 33 Other Conditions Treated. Asthma 19 Bronchitis 9 Bronchiectasis 1 Anterior poliomyelitis 3 106 Admissions to Hospital. Eleven children were admitted to hospital and the following operations performed :— 1. Tenotomy to left sterno-mastoid. 2. Bone graft left clavicle. 3. Wedge and osteotomy left hallux. 4. Arthrodesis digit 2nd right foot. 5. ,, , 1st left hand. 6. „ ,, 2nd right and left feet. 7. Bone-drilling patoellae. 8. Tenotomy digit 5th right and left feet. 9. ,, ,, 5th right and left feet. 10. Rotary osteotomy and bone peg right radius. 11. Tenotomy left tendo Achilles. Surgical Appliances and Boots. Minor alterations to shoes (wedges, etc.) 37 Metatarsal bars 5 Artificial Sunlight Clinic. Number of children who attended 172 Attendances made 1,259 Conditions Treated :— General debility 44 Rickets 5 Bronchitis 24 Coughs and colds 9 Rheumatism 3 Gingivitis 1 Septic sores 6 Psoriasis 2 Asthma 19 Cervical adenitis 1 Conjunctivitis 1 Scabies 3 Boils 5 Vitamin deficiency 1 Otitis media 1 107 HANDICAPPED PUPILS. Medical Examinations. During the year, some 123 children were referred for special medical examination. As the result of examination these 123 children were classified as follows :— Deaf 1 Delicate 89 Educationally sub-normal 25 Physically handicapped 1 Unfit for education within the school system 7 123 In addition to the above, 27 children were examined because of difficulties at home or school, and were ascertained as set out below: Behaviour problems 15 Dull and backward 10 Backward only 2 27 Several of these children are being referred to the Child Guidance Clinic for appropriate treatment. Special School for Educationally Sub-Normal Pupils. Admitted 48 Discharged 12 Physically Handicapped Pupils. Knotts Green Open Air School. Admitted during the year 31 Discharged 27 108 PROVISION OF MEALS. The number of individual children fed under the Authority arrangements during 1948 was :— Dinners. Milk Meals. Free 1,591 11,382 For payment 8,059 — Totals 9,650 11,382 Number of meals supplied :— Dinners. Milk Meals. Free 218,317 1,996,205 For payment 1,053,822 — Totals 1,272,139 1,996,205 SPEECH THERAPY. The following summary shows the number of children treated and the speech defects from which they were considered to be suffering :— 1. Children at present Undergoing Treatment— Diagnosis of Defects— Boys Girls Total Stammering 42 10 52 Dyslalia 31 7 38 Sigmatism 3 3 6 Lisp 1 4 5 Deafness 1 — 1 Cleft palate 1 1 2 79 25 104 Incidence of speech defects among seniors, juniors and infants— Seniors Juniors Infants Total Stammering 14 20 18 52 Dyslalia — 8 30 38 Sigmatism — 2 4 6 Others 1 2 5 8 15 32 57 104 109 2. Discharged—53. Seniors Juniors Infants Total Dyslalia — 6 17 23 Stammering 4 6 7 17 Sigmatism — 3 4 7 Lisp 1 — 3 4 Others — 1 1 2 5 16 32 53 3. On Waiting List 37 4. Average Number of Cases Treated Daily 26 5. Homes Visited 124 6. Schools Visited 47 7. Children referred to other Clinics :— To the Psychiatrist 3 To the Psychologist 9 For further medical advice 6 For dental treatment 8 26 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 1,200 Second Age Group 1,062 Third Age Group 1,018 Total 3,280 b. Other Inspections. Number of Special Inspections 4,639 Number of Re-inspections 8,458 Total 13,097 110 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 14 219 212 17.6 Second Age Group ... 41 113 151 14.2 Third Age Group 55 79 124 12.1 Total (Prescribed Groups) 110 411 487 14.8 Other Routine Inspections — — — — Grand Total 110 411 487 14.8 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1948. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin 8 13 506 - Eyes—(a) Vision 110 24 135 1 (b) Squint 31 16 30 - (c) Other 15 10 453 — Ears—(a) Hearing 7 6 15 1 (6) Otitis Media 14 27 89 - (c) Other 8 3 422 - Nose or Throat 76 120 581 1 Speech 8 20 39 2 Cervical Glands 6 53 54 1 Heart and Circulation 3 17 13 — Lungs 13 43 143 2 Developmental—(a) Hernia 6 6 5 — (6) Other 8 24 79 — Orthopaedic—(a) Posture 11 12 12 — (b) Flat Foot 63 20 29 — (c) Other 68 30 92 2 Nervous System—(a) Epilepsy 2 1 10 — (b) Other 13 8 69 1 Psychological—(a) Development 2 2 ' 16 1 (b) Stability 6 40 82 — Other 43 25 3,538 7 111 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 1,200 288 24.0 790 65.8 122 10.1 Second Age Group 1,062 282 26.5 721 67.9 59 5.5 Third Age Group 1,018 565 55.5 443 43.5 10 0.9 Other Routine Inspections — — — — — — — Total 3,280 1,135 34.6 1,954 59.5 191 5.8 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1948. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table V). Disease or Defect. Number of Defects treated or under treatment during the year. (1) Skin— Ringworm— Scalp-r—(1) X-ray treatment (2) Other 6 Body 8 Scabies 10 Impetigo 18 Other skin diseases 459 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 453 Minor Ear Defects 429 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1803 Total 3186 112 TABLE III.—conld. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated a3 minor ailments. group I). Defect or Disease. Number of Defects dealt with. Errors of refraction (including squint) 562 Other defect or disease of the eyes (excluding those recorded in Group I) 117 Total 679 No. of Pupils for whom Spectacles were— (a) Prescribed 339 (6) Obtained 339 Group III.— Treatment of Defects of Nose and Throat. Total number treated. Received operative treatment:— (a) for adenoids and chronic tonsillitis 119 (b) for other nose and throat conditions 14 Received other forms of treatment 79 212 Group IV.—Orthopædic and Postural Defects. (a) No. treated as in-patients in hospitals or hospital schools 11 (b) No. treated otherwise, e.g., in clinics or patient departments 639 Group V.—Child Guidance Treatment and Speech Therapy. No. of pupils treated— (a) Under Child Guidance arrangements 14 (b) Under Speech Therapy arrangements 104 113 TABLE IV. Dental Inspection and Treatment (1) Number of pupils who were :— (a) Inspected by the Dentist:— Age Groups Aged: ! Total 8,407 3 4 132 5 780 6 935 7 751 8 835 9 775 10 711 11 835 12 848 13 838 14 600 15 257 16 59 17 42 18 9 J Specials (Casuals) 2,165 Grand Total 10,572 (6) Found to require treatment 4,229 (c) Actually treated 3,216 (2) Half-days devoted to Inspection 56 Treatment 848— Total 904 (3) Attendances made by children for treatment 7,974 (4) Fillings, Permanent Teeth 2,374 Temporary „ 936 —Total 3,310 (5) Extractions, Permanent Teeth 773 Temporary ,, 5,385 Total 6,158 (6) Administrations of general anaesthetics for extractions 2,778 (7) Other operations, Permanent Teeth 1,471 Temporary „ 1,246—Tota 2,717 114 TABLE V. Infestation with Vermin. (1) Total number of examinations in the Schools by School Nurses 28,422 (2) Number of individual pupils found to be infested 853 (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.) —